Individual
MADISON CALDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACMHC, PCLC, LCPC
Contact information
Practice address
1075 E PARK BLVD, BOISE, ID 83712-7722
(208) 381-5970
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
11150725-6009
UT
101YM0800X
Mental Health Counselor
BBH-PCLC-LIC-31712
MT
101YM0800X
Mental Health Counselor
Primary
—
ID
Other
Enumeration date
09/02/2020
Last updated
04/18/2022
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