Individual
WILLIAM DALE GOULART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2463 E GALA ST, MERIDIAN, ID 83642-5209
(717) 858-3641
Mailing address
252 N SHILLING AVE APT 4, BLACKFOOT, ID 83221-2364
(717) 858-3641
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
07/24/2024
Last updated
07/24/2024
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