Individual
MR. NATHANIEL BONOVITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
1151 E IRON EAGLE DR, EAGLE, ID 83616-6854
(484) 557-5672
Mailing address
3631 OVERLAND RD, BOISE, ID 83705-6033
(208) 343-0441
(208) 343-4993
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
4869
ID
101YM0800X
Mental Health Counselor
Primary
LPC
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC #3820
LPC NUMBER
ID
Enumeration date
07/24/2008
Last updated
06/12/2023
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