Individual
BRYAN G BUMGARNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
500 W FORT ST, B-114, BOISE, ID 83702-4501
(208) 422-1000
(208) 422-1241
Mailing address
500 W FORT ST, B-114/RIVER ST, BOISE, ID 83702-4501
(208) 422-1000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
30983
ID
Other
Enumeration date
10/02/2009
Last updated
01/11/2023
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