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General NPI Number Information
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NPI Number | 1386526267
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Entity Type | Individual
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Provider Name | BRIAN ROBERTS PARISH IADC
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Gender | Male
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 630 ADDISON AVE W STE 100
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City | TWIN FALLS
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State | ID
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Zip | 83301-5491
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Country | US
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Telephone | 208-736-5048
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Fax | 208-735-2126
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Provider Business Mailing Address
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Address Line | 305 8TH AVE E
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City | JEROME
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State | ID
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Zip | 83338-1812
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Country | US
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Telephone | 208-731-3881
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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 | 51101
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License Number State | ID
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