Doctor Name: | DAVID AVERILL |
NPI Number: | 1023234614 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCPC |
License Number: | LCPC-3662 |
Business Practice Address: | 4460 Kings Way Ste 2 Chubbuck, ID - 832021900 |
Business Phone Number: | 2082371711 |
Business Fax Number: | 2082375192 |
Mailing Address: | 4460 Kings Way Ste 2, CHUBBUCK |
State: | ID |
Postal Code: | 832021900 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/18/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LCPC-3662 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |