Individual
CASEY MOYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
322 E FRONT ST STE 400, BOISE, ID 83702-7370
(208) 914-2264
Mailing address
322 E FRONT ST STE 400, BOISE, ID 83702-7370
(208) 914-2264
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LMSW-29152
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001523970
OPTUM
—
Enumeration date
12/10/2020
Last updated
12/10/2020
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