Individual
BLAKE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
9196 W EMERALD ST STE 130, BOISE, ID 83704-8003
(208) 323-4400
Mailing address
9196 W EMERALD ST STE 130, BOISE, ID 83704-8003
(208) 323-4400
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
9771552
ID
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/13/2024
Last updated
04/18/2026
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