Individual
MR. BRENT R CUNNINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC, LSAC
Contact information
Practice address
284 MARTIN ST, TWIN FALLS, ID 83301-4542
(208) 420-9952
(208) 423-7029
Mailing address
PO BOX 242, TWIN FALLS, ID 83303-0242
(208) 420-9952
(208) 423-7029
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1021897 CADC
ID
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
7726920-6006
UT
Other
Enumeration date
04/30/2011
Last updated
04/30/2011
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