Healthcare Provider Details

I. General information

NPI: 1760756266
Provider Name (Legal Business Name): PHILLIP RODNEY HOBSON II LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13447 W WALDEMAR ST
BOISE ID
83713-0843
US

IV. Provider business mailing address

784 S CLEARWATER LOOP # 4079
POST FALLS ID
83854-9599
US

V. Phone/Fax

Practice location:
  • Phone: 251-463-2824
  • Fax: 208-203-6121
Mailing address:
  • Phone: 251-463-2824
  • Fax: 208-203-6121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1331
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT128156
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006481
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-10281
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: