Individual
MR. TRAVIS DEAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC, ACADC
Contact information
Practice address
8258 W ORBIT DR, BOISE, ID 83709-7876
(208) 850-2798
Mailing address
8258 W ORBIT DR, BOISE, ID 83709-7876
(208) 850-2798
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-3432
ID
Other
Enumeration date
04/17/2007
Last updated
07/08/2007
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