Individual
DESTENI NEILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1276 W RIVER ST STE 100, BOISE, ID 83702-7083
(208) 338-4699
Mailing address
3408 N 33RD ST, BOISE, ID 83703-4954
(208) 794-2242
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LMSW-39056
ID
Other
Enumeration date
01/31/2020
Last updated
01/31/2020
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