Individual
DAVID AVERILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
4460 KINGS WAY STE 2, CHUBBUCK, ID 83202-1900
(208) 237-1711
(208) 237-5192
Mailing address
4460 KINGS WAY STE 2, CHUBBUCK, ID 83202-1900
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-3662
ID
Other
Enumeration date
04/18/2007
Last updated
07/09/2007
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