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General NPI Number Information
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NPI Number | 1255813044
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Entity Type | Individual
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Provider Name | AARON ELIAS ST.GEORGE B.S., CADC
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Gender | Male
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Dates
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Enumeration Date | 08/29/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 524 CLEVELAND BLVD STE 230
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City | CALDWELL
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State | ID
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Zip | 83605-4080
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Country | US
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Telephone | 208-800-0588
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Fax | 208-800-0599
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Provider Business Mailing Address
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Address Line | 524 CLEVELAND BLVD STE 230
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City | CALDWELL
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State | ID
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Zip | 83605-4080
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Country | US
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Telephone | 208-800-0588
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Fax | 208-800-0599
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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 | 11542
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License Number State | ID
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