Individual
CARSON SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
220 W GEORGIA AVE, NAMPA, ID 83686-2835
(425) 368-3262
Mailing address
1809 W CAMELOT DR, NAMPA, ID 83651-8815
(623) 235-5395
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/28/2022
Last updated
07/28/2022
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