Individual
MARK KEYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
3402 FRANKLIN RD, CALDWELL, ID 83605-6932
(208) 455-7061
(208) 454-7714
Mailing address
11642 W WAGON PASS ST, BOISE, ID 83709-8566
(208) 982-7177
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-35786
ID
Other
Enumeration date
08/19/2016
Last updated
08/19/2016
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