Individual
MR. BO ROBERT SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1309 CAMAS ST, BLACKFOOT, ID 83221-3060
(208) 782-0675
Mailing address
297 PENDLEBURY LN APT 1, BLACKFOOT, ID 83221-2815
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3071150
ID
Other
Enumeration date
02/28/2025
Last updated
02/28/2025
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