Individual
BLAIR K GARNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2235 E 25TH ST STE 185, IDAHO FALLS, ID 83404-7539
(208) 522-1904
(208) 522-8847
Mailing address
2235 E 25TH ST STE 185, IDAHO FALLS, ID 83404-7539
(208) 522-1904
(208) 522-8847
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-582
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010015892
BLUE SHIELD PROVIDER NUMB
ID
01
—
L5824
BLUE CROSS PROVIDER NUMBE
ID
Enumeration date
01/12/2007
Last updated
12/21/2011
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