Individual
SEBASTIAN MOAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1188 E BERGESON ST, BOISE, ID 83706-5802
(208) 697-2590
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
IC-1615
NV
1041C0700X
Clinical Social Worker
Primary
LCSW-43908
ID
Other
Enumeration date
09/12/2020
Last updated
03/12/2026
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