Individual
VICTOR KIERNAN THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4650 HAWTHORNE RD STE 3B, CHUBBUCK, ID 83202-2376
(208) 648-4167
Mailing address
4650 HAWTHORNE RD, CHUBBUCK, ID 83202-2376
(208) 648-4167
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
10431
ID
Other
Enumeration date
06/05/2024
Last updated
06/05/2024
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