Individual
ETHAN D BONHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
921 S 8TH AVE, POCATELLO, ID 83201-5377
(816) 977-7323
Mailing address
921 S 8TH AVE, POCATELLO, ID 83201-5377
(816) 977-7323
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7481011
ID
Other
Enumeration date
06/01/2026
Last updated
06/01/2026
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