Individual
COLIN WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2705 E 17TH ST, AMMON, ID 83406-6601
(208) 346-7500
Mailing address
2705 E 17TH ST, AMMON, ID 83406-6601
(208) 346-7500
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-6309
ID
Other
Enumeration date
07/21/2016
Last updated
07/21/2016
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