Individual
STEVEN D PROCTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
651 MEMORIAL DR, POCATELLO, ID 83201-4071
(208) 239-2110
(208) 239-2136
Mailing address
651 MEMORIAL DR, POCATELLO, ID 83201-4071
(208) 239-2110
(208) 239-2136
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW-1186
IDAHO STATE LICENSE
ID
Enumeration date
06/11/2008
Last updated
06/11/2008
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