Individual
ZACHARY WIXOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
150 SHOUP AVE, IDAHO FALLS, ID 83402-3657
(208) 528-5712
Mailing address
150 SHOUP AVE, IDAHO FALLS, ID 83402-3657
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/07/2018
Last updated
05/07/2018
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