Individual
MR. BOBBY LEON PASCOE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1706 G ST, LEWISTON, ID 83501-2021
(208) 751-0478
Mailing address
155 2ND AVE N, TWIN FALLS, ID 83301-6162
(208) 751-0478
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LPC-9755
ID
Other
Enumeration date
10/02/2023
Last updated
10/02/2023
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