Individual
RONALD KYLE SEBREROS I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2100 ALAN ST, IDAHO FALLS, ID 83404-5801
(208) 528-7655
(208) 524-9390
Mailing address
2100 ALAN ST, IDAHO FALLS, ID 83404-5801
(208) 528-7655
(208) 542-9390
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LCSW-34256
ID
Other
Enumeration date
04/11/2012
Last updated
04/10/2024
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