Individual
CORY BEACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6485 W INTERCHANGE LN STE 110, BOISE, ID 83709-2102
(208) 402-8406
Mailing address
11702 W TIOGA ST, BOISE, ID 83709-3351
(303) 929-1373
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
0009920848
CO
104100000X
Social Worker
LMSW-35194
ID
1041C0700X
Clinical Social Worker
Primary
39008
ID
Other
Enumeration date
03/22/2016
Last updated
02/28/2024
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