Individual
ROGER EVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW-44535
Contact information
Practice address
3076 N FIVE MILE RD, BOISE, ID 83713-5215
(208) 376-4999
Mailing address
3076 N FIVE MILE RD, BOISE, ID 83713-5215
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-44535
ID
101YM0800X
Mental Health Counselor
LMSW-40940
ID
Other
Enumeration date
06/21/2021
Last updated
02/02/2024
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