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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARY M MCEVILLY LCSW (DIRECTOR)
(208) 336-4504
Entity
Organization

Contact information

Practice address
1111 S ORCHARD ST, SUITE 650, BOISE, ID 83705-1966
(208) 336-4504
(208) 336-0720
Mailing address
1111 S ORCHARD ST, SUITE 650, BOISE, ID 83705-1966
(208) 385-7711
(208) 385-0346

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW830
ID
101YM0800X
Mental Health Counselor
NP458A
ID

Other

Enumeration date
06/11/2006
Last updated
08/22/2020
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