Individual
AMANDA JEAN DAVIS GLEIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
211 16TH AVE N, NAMPA, ID 83687-4058
(406) 210-5481
Mailing address
211 16TH AVE N, PO BOX 9, NAMPA, ID 83653-0009
(406) 210-5481
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6662
ID
101YM0800X
Mental Health Counselor
BBH-LCPC-LIC-23179
MT
Other
Enumeration date
03/09/2011
Last updated
03/30/2018
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