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General NPI Number Information
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NPI Number | 1497604912
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Entity Type | Individual
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Provider Name | JEREMY ROBERTSON
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Gender |
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 1910 UNIVERSITY DR
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City | BOISE
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State | ID
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Zip | 83725-0001
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Country | US
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Telephone | 208-426-1459
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Fax |
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Provider Business Mailing Address
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Address Line | 4735 ADAMS ST
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City | GARDEN CITY
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State | ID
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Zip | 83714-4747
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6371294
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License Number State | ID
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