Healthcare Provider Details

I. General information

NPI: 1104558337
Provider Name (Legal Business Name): JOSE LUIS ARZOLA JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6126 W STATE ST STE 402
BOISE ID
83703-2741
US

IV. Provider business mailing address

6126 W STATE ST STE 402
BOISE ID
83703-2741
US

V. Phone/Fax

Practice location:
  • Phone: 208-406-6565
  • Fax: 208-322-1103
Mailing address:
  • Phone: 208-406-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8911063
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: