Individual
DIANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2131 S BONITO WAY, MERIDIAN, ID 83642-1659
(208) 202-4732
Mailing address
2131 S BONITO WAY, MERIDIAN, ID 83642-1659
(208) 202-4732
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
C7279
OR
101Y00000X
Counselor
Primary
LCPC-8350
ID
101Y00000X
Counselor
—
—
Other
Enumeration date
11/14/2017
Last updated
05/01/2024
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