Individual
MR. MATTHEW BLAISE MCDANIEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
9196 W BARNES DR, BOISE, ID 83709-1552
(208) 433-0400
(208) 378-5824
Mailing address
9196 W BARNES DR, BOISE, ID 83709-1552
(208) 433-4000
(208) 378-5824
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LMSW-38732
ID
Other
Enumeration date
12/22/2020
Last updated
12/22/2020
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