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Behavioral Analyst

Fort Hall, Idaho

Provider NPI: 1043541543

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 208-238-2400  Fax: 208-238-5462

Business Mailing Address:
Tel: 208-238-2400  Fax: 208-238-5462

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number


Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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