Organization
NEW AGE MED CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES DONNELLY (CO-OWNER)
(208) 573-3053
Entity
Organization
Contact information
Practice address
3501 W ELDER ST STE 102, BOISE, ID 83705-4986
(208) 573-3053
Mailing address
4320 W EDGEMONT ST, BOISE, ID 83706-2304
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171400000X
Health & Wellness Coach
—
—
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
Primary
—
—
Other
Enumeration date
10/13/2025
Last updated
10/13/2025
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