Individual
KYLE HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
421 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 234-7900
Mailing address
421 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 234-7900
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5356
ID
Other
Enumeration date
05/09/2016
Last updated
05/09/2016
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