Healthcare Provider Details

I. General information

NPI: 1366290389
Provider Name (Legal Business Name): JOSHUA BEFUS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 CLEVELAND BLVD STE 205
CALDWELL ID
83605-4080
US

IV. Provider business mailing address

11315 HALL DR
NAMPA ID
83651-8043
US

V. Phone/Fax

Practice location:
  • Phone: 208-643-7972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10436
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: