Healthcare Provider Details

I. General information

NPI: 1740928076
Provider Name (Legal Business Name): CONNER JAMES VRBA LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1982 BENGAL VIEW DR
POCATELLO ID
83201-4994
US

IV. Provider business mailing address

1982 BENGAL VIEW DR
POCATELLO ID
83201-4994
US

V. Phone/Fax

Practice location:
  • Phone: 208-252-5540
  • Fax:
Mailing address:
  • Phone: 208-252-5540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-8900
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: