Individual
MIGUEL ANGEL MOUW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ICADC
Contact information
Practice address
205 OAKHURST WAY, BOISE, ID 83709-0534
(208) 353-5846
Mailing address
205 OAKHURST WAY, BOISE, ID 83709-0534
(208) 353-5846
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1360009
ID
Other
Enumeration date
07/31/2012
Last updated
07/31/2012
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