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General NPI Number Information
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NPI Number | 1376178210
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Entity Type | Individual
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Provider Name | WALTER JAMES MELDRUM CADC, BS, QSUDP
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Gender | Male
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 1299 N ORCHARD ST STE 110
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City | BOISE
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State | ID
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Zip | 83706-2266
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Country | US
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Telephone | 208-672-3426
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Fax |
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Provider Business Mailing Address
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Address Line | 1682 E TIME ZONE DR
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City | MERIDIAN
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State | ID
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Zip | 83642-4500
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Country | US
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Telephone | 208-351-2765
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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 | 11733
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License Number State | ID
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