Individual
MR. BEVIN JAY MODRAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
204 S COLE RD, BOISE, ID 83709-0934
(208) 319-9786
(208) 319-7773
Mailing address
6568 S FEDERAL WAY, #124, BOISE, ID 83716-9277
(208) 283-9710
(208) 319-7773
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC4698
ID
Other
Enumeration date
12/02/2011
Last updated
03/29/2023
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