Individual
LILLY BWANGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8620 W EMERALD ST STE 150, BOISE, ID 83704-4839
(208) 617-3265
Mailing address
718 W QUAKING ASPEN DR, KUNA, ID 83634-5498
(208) 863-2126
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
ID
Other
Enumeration date
04/10/2023
Last updated
05/12/2026
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