Individual
ETHAN BRYAN BOOKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1302 E 17TH ST, IDAHO FALLS, ID 83404-6270
(208) 542-9919
Mailing address
678 FOSTER DR, IDAHO FALLS, ID 83401-5243
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6171695
ID
104100000X
Social Worker
Primary
6171695
ID
Other
Enumeration date
03/10/2026
Last updated
08/03/2026
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