Individual
BRYAN WINWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
75 S 1ST W, PRESTON, ID 83263-1204
(208) 339-0227
Mailing address
75 S 1ST W, PRESTON, ID 83263-1204
(208) 851-1073
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-9171
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LPC-9171
—
ID
Enumeration date
10/25/2022
Last updated
10/25/2022
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