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General NPI Number Information
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NPI Number | 1619742970
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Entity Type | Individual
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Provider Name | MR. JAMES MARSHALL III
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Gender | Male
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Dates
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Enumeration Date | 11/16/2023
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 2337 3RD AVE N STE A
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City | LEWISTON
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State | ID
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Zip | 83501-1625
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Country | US
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Telephone | 208-848-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 6554 COUGAR RIDGE DR
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City | LEWISTON
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State | ID
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Zip | 83501-7854
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Country | US
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Telephone | 208-305-4251
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | ID
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