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Individual

DR. RENEE LYNN BOZORG-OMID

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
500 S 11TH AVE STE 302, POCATELLO, ID 83201-4879
(208) 233-0150
Mailing address
PO BOX 4455, POCATELLO, ID 83205-4455
(912) 660-2674

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC 3249
ID

Other

Enumeration date
01/15/2009
Last updated
01/15/2009
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