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Individual

MR. MATTHEW CHARLES GENUCHI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
112 12TH AVE RD, NAMPA, ID 83686-5011
(208) 465-5433
Mailing address
112 12TH AVE RD, NAMPA, ID 83686-5011
(208) 465-5433

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4456
ID

Other

Enumeration date
02/15/2010
Last updated
02/15/2010
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