Individual
MR. TIMOTHY STEPHEN DESANTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
8620 W EMERALD ST, SUITE 150, BOISE, ID 83704-4824
(208) 672-2900
(208) 672-2919
Mailing address
1410 CHELSEY CIR, MOUNTAIN HOME, ID 83647-4634
(208) 672-8764
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCPC-4671
ID
Other
Enumeration date
05/07/2013
Last updated
05/07/2013
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