Healthcare Provider Details

I. General information

NPI: 1144387598
Provider Name (Legal Business Name): FREDERICK EDWARD HOADLEY D. MIN.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 W TAFT ST
BOISE ID
83703-4148
US

IV. Provider business mailing address

1369 S SPRING VALLEY DR
NAMPA ID
83686-3108
US

V. Phone/Fax

Practice location:
  • Phone: 208-344-0051
  • Fax:
Mailing address:
  • Phone: 208-442-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT - 3266
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: