Individual
MR. LYLE SPENCER BOURCY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
1303 NW 16TH ST, SUITE C, FRUITLAND, ID 83619-2263
(208) 250-0374
(208) 452-2164
Mailing address
1303 NW 16TH ST, SUITE C, FRUITLAND, ID 83619-2263
(208) 250-0374
(208) 452-2164
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC-2757
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000101364
BLUE SHIELD OF IDAHO
ID
01
—
Q3543
BLUE CROSS OF IDAHO PROVI
ID
Enumeration date
08/02/2005
Last updated
07/09/2007
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