Individual
BRANDON SHORES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
1720 N WESTGATE DR, BOISE, ID 83704-7164
(208) 334-0810
(208) 334-0812
Mailing address
1720 N WESTGATE DR, BOISE, ID 83704-7164
(208) 334-0810
(208) 334-0812
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/23/2016
Last updated
03/23/2016
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