Individual
BRIAN EZRA LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
13500 S PLEASANT VALLEY RD, KUNA, ID 83634-7341
(208) 336-0740
Mailing address
PO BOX 14, BOISE, ID 83707-0014
(208) 336-0740
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-32235
ID
Other
Enumeration date
06/25/2012
Last updated
01/29/2015
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