Individual
BRYAN LEON GIMMESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
236 RADAR RD, COTTONWOOD, ID 83522-5165
(208) 962-3276
Mailing address
1902 LEWISTON ST, COTTONWOOD, ID 83522-5071
(208) 962-7217
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-3905
ID
Other
Enumeration date
09/11/2013
Last updated
09/11/2013
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