STATE OF IDAHO

BOISE, ID
NPI1790131027
Entity TypeOrganization
Authorized ContactWAYNE NUBILE
Clinical Supervisor
208-334-0824
Organization Subpart ?No
Primary Taxonomy251S00000X 
(Licence: ID  LCPC-5579)
Enumeration Date2016-05-05
Last Update Date2016-05-05
Business Address
STATE OF IDAHO
1720 N WESTGATE DR
BOISE, ID 83704-7164
Phone number: 208-334-0824
Mailing Address
STATE OF IDAHO
2322 W STATE ST
BOISE, ID 83702-3161
Phone number: 208-334-0824
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