Individual
IVORY BOSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
148 S COLE RD, BOISE, ID 83709-0932
(208) 683-8320
Mailing address
148 S COLE RD, BOISE, ID 83709-0932
(208) 683-8320
(208) 969-8380
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
42295
ID
Other
Enumeration date
06/13/2022
Last updated
06/13/2022
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