Healthcare Provider Details

I. General information

NPI: 1427734912
Provider Name (Legal Business Name): DADDY BOY HUDDY-NAHALEA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12553 W EXPLORER DR STE 190
BOISE ID
83713-1612
US

IV. Provider business mailing address

12553 W EXPLORER DR STE 190
BOISE ID
83713-1612
US

V. Phone/Fax

Practice location:
  • Phone: 208-376-7083
  • Fax:
Mailing address:
  • Phone: 208-376-7083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-9607
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-9607
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: