Individual
RANDY WILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
3152 S BOWN WAY STE 103, BOISE, ID 83706-5456
(541) 550-7940
(541) 550-7941
Mailing address
3152 S BOWN WAY STE 103, BOISE, ID 83706-5456
(541) 550-7940
(541) 550-7941
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C1740
OR
Other
Enumeration date
06/13/2007
Last updated
02/14/2024
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