Individual
MR. BLAINE COLIN REILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
2971 E COPPER POINT DR STE 100, MERIDIAN, ID 83642-9276
(208) 376-5683
(208) 376-5690
Mailing address
4048 S IRIONDO WAY, BOISE, ID 83706-5784
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4470
ID
Other
Enumeration date
10/24/2007
Last updated
02/16/2024
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