Individual
GAVIN WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
522 LOMAX ST, IDAHO FALLS, ID 83401
(208) 522-6925
(208) 522-6934
Mailing address
522 LOMAX ST, IDAHO FALLS, ID 83401
(208) 522-6925
(208) 522-6934
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11391
ID
Other
Enumeration date
12/07/2023
Last updated
12/07/2023
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