Organization
PRACTICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS THOMS (MANAGING MEMBER)
(505) 385-6305
Entity
Organization
Contact information
Practice address
1111 S ORCHARD ST, BOISE, ID 83705-1966
(208) 900-3678
Mailing address
9546 W MOSSYWOOD DR, BOISE, ID 83709-5333
(505) 385-6305
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/22/2021
Last updated
10/22/2021
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