Healthcare Provider Details

I. General information

NPI: 1700796976
Provider Name (Legal Business Name): NICHOLAS ESPOSITO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4477 W EMERALD ST STE C125
BOISE ID
83706-2000
US

IV. Provider business mailing address

4435 N OXBOW PL
BOISE ID
83713-2697
US

V. Phone/Fax

Practice location:
  • Phone: 208-495-4437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5281230
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: