Organization
STATE OF IDAHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYNE NUBILE LCPC (CLINICAL SUPERVISOR)
(208) 334-0824
Entity
Organization
Contact information
Practice address
1720 N WESTGATE DR, BOISE, ID 83704-7164
(208) 334-0824
Mailing address
2322 W STATE ST, BOISE, ID 83702-3161
(208) 334-0824
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LCPC-5579
ID
Other
Enumeration date
05/05/2016
Last updated
05/05/2016
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