Individual
MR. KORY DAVID WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC-3463
Contact information
Practice address
218 DIVIDEND DR STE 3, REXBURG, ID 83440-3510
(208) 359-9683
(208) 359-9683
Mailing address
490 PIONEER RD APT 8301, REXBURG, ID 83440-5285
(208) 521-8173
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-3463
ID
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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