Individual
KENT THIBAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW, CADC
Contact information
Practice address
251 N 300 E, JEROME, ID 83338-5451
(208) 324-8284
(208) 324-8284
Mailing address
251 N 300 E, JEROME, ID 83338-5451
(208) 324-8284
(208) 324-8284
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-28571
ID
Other
Enumeration date
10/20/2011
Last updated
10/20/2011
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