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General NPI Number Information
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NPI Number | 1154187284
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Entity Type | Individual
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Provider Name | JOSH COLES
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Gender | Male
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 06/14/2024
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Provider Practice Location Address
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Address Line | 366 SW 5TH AVE STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-8600
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Country | US
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Telephone | 208-898-9755
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Fax |
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Provider Business Mailing Address
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Address Line | 411 N. ALLUMBAUGH
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | ID
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