MEDICARE: RD BOARDMAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	PSY - 202708	ID

General Provider Information

NPI Number	:	1336477207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RD BOARDMAN LPC

Provider Business Mailing Address
First Line	:	HEALTH SERVICES 1529 BELMONT ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83725-0001
Country	:	US
Telephone Number	:	208-426-1459
Fax Number	:	208-426-3005

Provider Business Practice Location Address
First Line	:	HEALTH SERVICES 1529 BELMONT ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83725-0001
Country	:	US
Telephone Number	:	208-426-1459
Fax Number	:	208-426-3005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2009
Last Update Date	:	10/12/2012

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Directions to “ RD BOARDMAN LPC” Practice Location

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