Individual
JUSTIN HIROSHI HIRASAKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
605 11TH AVE E, GOODING, ID 83330-5368
(208) 934-8461
(208) 934-5437
Mailing address
842 JEFFERSON ST, MONTPELIER, ID 83254-1452
(808) 277-8075
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10267
ID
Other
Enumeration date
06/03/2015
Last updated
06/03/2015
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