Individual
MICHAELA WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
148 S COLE RD, BOISE, ID 83709-0932
(208) 683-8320
Mailing address
450 W GROVE ST APT 408, BOISE, ID 83702-7282
(805) 660-3618
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/23/2024
Last updated
08/23/2024
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