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1821534017
MAI LE PROVENCIO
BOISE, ID
NPI
1821534017
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: ID LCSW-34323)
Enumeration Date
2017-01-11
Last Update Date
2024-10-23
Business Address
MAI LE PROVENCIO LCSW
7235 W POTOMAC DR STE 220
BOISE, ID 83704-9133
Phone number: 208-794-9703
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Mailing Address
MAI LE PROVENCIO LCSW
7235 W POTOMAC DR STE 220
BOISE, ID 83704-9133
Phone number: 208-576-0571
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