Individual
EDWARD MATHEWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ISAS
Contact information
Practice address
482 CONSTITUTION WAY, SUITE 110, IDAHO FALLS, ID 83402-3565
(208) 932-4493
Mailing address
482 CONSTITUTION WAY, SUITE 110, IDAHO FALLS, ID 83402-3565
(208) 932-4493
(208) 932-4582
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ISAS-10328
ID
Other
Enumeration date
07/12/2016
Last updated
07/12/2016
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