Individual
MR. CHARLES BENTON MCCONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
413 N ALLUMBAUGH, SUITE 103, BOISE, ID 83704
(208) 658-0800
(208) 323-1894
Mailing address
413 N ALLUMBAUGH, SUITE 103, BOISE, ID 83704
(208) 658-0800
(208) 323-1894
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPCP 127
ID
Other
Enumeration date
08/21/2006
Last updated
07/08/2007
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