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1740057918
GAVIN WELLS
IDAHO FALLS, ID
NPI
1740057918
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: ID 11391)
Enumeration Date
2023-12-07
Last Update Date
2023-12-07
Business Address
GAVIN WELLS CADC
522 LOMAX ST
IDAHO FALLS, ID 83401
Phone number: 208-522-6925
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Mailing Address
GAVIN WELLS CADC
522 LOMAX ST
IDAHO FALLS, ID 83401
Phone number: 208-522-6925
Copy
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