Individual
QUINN BLAKE THIBODEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, NCC, M. COUN
Contact information
Practice address
1891 GRANDVIEW CT, IDAHO FALLS, ID 83402-2510
(208) 681-7182
Mailing address
1891 GRANDVIEW CT, IDAHO FALLS, ID 83402-2510
(208) 681-7182
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-4361
ID
104100000X
Social Worker
—
—
Other
Enumeration date
05/27/2009
Last updated
08/12/2009
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