Healthcare Provider Details

I. General information

NPI: 1982006433
Provider Name (Legal Business Name): SCOTT URBAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W. MAIN STREET
KUNA ID
83634-0900
US

IV. Provider business mailing address

PO BOX 959
KUNA ID
83634-0900
US

V. Phone/Fax

Practice location:
  • Phone: 208-922-9001
  • Fax: 208-922-3778
Mailing address:
  • Phone: 208-922-9001
  • Fax: 208-922-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-5682
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: