Healthcare Provider Details

I. General information

NPI: 1730367053
Provider Name (Legal Business Name): LELAND EUGENE ESLINGER LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1284 E 16TH ST
IDAHO FALLS ID
83404-5463
US

IV. Provider business mailing address

1284 E 16TH ST
IDAHO FALLS ID
83404-5463
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-9331
  • Fax: 208-522-9331
Mailing address:
  • Phone: 208-522-9331
  • Fax: 208-522-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC-150
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: