Individual
DREW HAROLD BURRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
717 MISSION RD, 306, FORT HALL, ID 83203-0306
(208) 238-2400
(208) 238-5462
Mailing address
717 MISSION RD, FORT HALL, ID 83203-0717
(208) 238-2400
(208) 238-5462
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LSW27969
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003399100
—
ID
Enumeration date
01/22/2010
Last updated
01/22/2010
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