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General NPI Number Information
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NPI Number | 1427933431
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Entity Type | Individual
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Provider Name | MECKAYDEN NIEZGODA
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Gender | Male
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 3663 N LAKEHARBOR LN
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City | BOISE
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State | ID
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Zip | 83703-6913
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Country | US
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Telephone | 208-565-7719
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Fax |
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Provider Business Mailing Address
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Address Line | 907 N MERCER ST
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City | BOISE
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State | ID
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Zip | 83703-5133
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5171667
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License Number State | ID
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