Individual
BENJAMIN SEYMOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CAC
Contact information
Practice address
1833 MILLENNIUM WAY SUITE# 120, MERIDIAN, ID 83642
(888) 277-0068
Mailing address
4419 NORTH SUPAI AVE., MERIDIAN, ID 83646
(208) 949-0363
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
65027
PA
Other
Enumeration date
06/20/2011
Last updated
06/20/2011
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