Healthcare Provider Details

I. General information

NPI: 1033027669
Provider Name (Legal Business Name): BRYCE DANIEL MARTIN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3852 N EAGLE RD
BOISE ID
83713-0750
US

IV. Provider business mailing address

708 N BROWNFIELD WAY
MERIDIAN ID
83642-7628
US

V. Phone/Fax

Practice location:
  • Phone: 208-378-0014
  • Fax:
Mailing address:
  • Phone: 208-391-1604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5081336
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: