Healthcare Provider Details

I. General information

NPI: 1205543824
Provider Name (Legal Business Name): OSCAR REYES LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 S COLE RD
BOISE ID
83709-0932
US

IV. Provider business mailing address

148 S COLE RD
BOISE ID
83709-0932
US

V. Phone/Fax

Practice location:
  • Phone: 208-683-8320
  • Fax: 208-969-8380
Mailing address:
  • Phone: 208-683-8320
  • Fax: 208-969-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-41526
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW-41526
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: