Individual
RUSTY O'LEARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1305 2ND ST S, SUITE 201, NAMPA, ID 83651-3944
(208) 463-0202
(208) 463-0205
Mailing address
1305 2ND ST S, SUITE 201, NAMPA, ID 83651-3944
(208) 463-0202
(208) 463-0205
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC-296
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCPC-296
ID PROFESSIONAL LICENSE
ID
Enumeration date
04/20/2007
Last updated
07/08/2007
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