Individual
BRIAN BUTLER MECHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1165 S UTAH AVE, IDAHO FALLS, ID 83402-3321
(208) 522-6155
(208) 522-6156
Mailing address
3069 SUMMERWOOD CIR, AMMON, ID 83406-7540
(208) 552-5816
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-1335
ID
Other
Enumeration date
06/14/2012
Last updated
06/14/2012
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