Organization
ACJCS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY SEAGRAVES LCSW (CLINICAL SUPERVISOR)
(208) 287-5624
Entity
Organization
Contact information
Practice address
400 N BENJAMIN LN, BOISE, ID 83704-5094
(208) 387-5600
Mailing address
400 N BENJAMIN LN, BOISE, ID 83704-5094
(208) 387-5600
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
22
ID
Other
Enumeration date
05/04/2015
Last updated
05/04/2015
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