Organization
IDAHO INSTITUTE OF GENDER AND SEX THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEREMY WAYNE IRVIN LCSW, M.ED., CST (OWNER)
(208) 417-8428
Entity
Organization
Contact information
Practice address
6003 W OVERLAND RD STE 105, BOISE, ID 83709-3075
(208) 417-8428
(208) 216-1434
Mailing address
3278 E RENWICK ST, MERIDIAN, ID 83642-6467
(208) 417-8428
(208) 216-1434
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
01/28/2019
Last updated
12/10/2021
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