Individual
JACOB COMSTOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
412 W PACIFIC ST, BLACKFOOT, ID 83221-1726
(208) 201-1743
Mailing address
2420E 25TH ST, IDAHO FALLS, ID 83404-7549
(208) 542-1026
(208) 528-2945
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCSW-34156
ID
Other
Enumeration date
04/02/2015
Last updated
09/28/2015
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