Healthcare Provider Details

I. General information

NPI: 1437933090
Provider Name (Legal Business Name): DELANEY BREANNE OBALDIA MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6853 N ROE AVE
BOISE ID
83714-2191
US

IV. Provider business mailing address

6853 N ROE AVE
BOISE ID
83714-2191
US

V. Phone/Fax

Practice location:
  • Phone: 951-398-9720
  • Fax:
Mailing address:
  • Phone: 951-398-9720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-9767
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: