Individual
MR. BRADLEY WARREN HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LMSW
Contact information
Practice address
323 12TH AVE RD, NAMPA, ID 83686-5014
(208) 463-0212
(208) 461-5452
Mailing address
1971 W MARTEN CREEK DR, MERIDIAN, ID 83646-4670
(208) 724-6460
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-33841
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LMSW-33841
STATE OF IDAHO, OFFICE OF OCCUPATIONAL LICENSES, STATE BOARD OF SOCIAL WORK
ID
Enumeration date
05/21/2014
Last updated
05/21/2014
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