Individual
MR. JEREMY WAYNE IRVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, MED
Contact information
Practice address
6003 W OVERLAND RD STE 105, BOISE, ID 83709-3075
(208) 417-8428
(208) 216-1434
Mailing address
3278 E RENWICK ST, MERIDIAN, ID 83642-6467
(208) 417-8428
(208) 216-1434
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-36060
ID
Other
Enumeration date
04/19/2016
Last updated
12/10/2021
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