Individual
NATHAN FAUNTLEROY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1529 BELMONT ST, BOISE, ID 83706
(208) 426-1459
Mailing address
1247 S DIVISION AVE, BOISE, ID 83706-3652
(317) 755-6008
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
38789
ID
Other
Enumeration date
06/25/2019
Last updated
06/25/2019
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