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General NPI Number Information
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NPI Number | 1639910078
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Entity Type | Individual
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Provider Name | TRENTON WILLIAM DELVA LPC
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Gender | Male
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 8152 NORTH WAYNE DRIVE
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City | HAYDEN
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State | ID
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Zip | 83835
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Country | US
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Telephone | 208-691-4687
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 RICHARDSON AVE
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City | LEWISTON
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State | ID
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Zip | 83501-5526
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Country | US
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Telephone | 208-848-6626
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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 | LPC-10552
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-10552
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License Number State | ID
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