Healthcare Provider Details

I. General information

NPI: 1639416175
Provider Name (Legal Business Name): DEBORAH JANE GREEN-COLBY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2273 S VISTA AVE STE 190
BOISE ID
83705-7341
US

IV. Provider business mailing address

1047 PEREGRINE DR
MIDDLETON ID
83644-5933
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-2737
  • Fax:
Mailing address:
  • Phone: 208-914-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMSW-29067
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: