Individual
BONITA JOY AVERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
1740 E 17TH ST, IDAHO FALLS, ID 83404-6375
(208) 346-8866
Mailing address
2705 E 17TH ST, AMMON, ID 83406-6601
(208) 346-7500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-5709
ID
Other
Enumeration date
04/20/2012
Last updated
02/14/2019
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