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General NPI Number Information
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NPI Number | 1922039262
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Entity Type | Individual
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Provider Name | JONATHAN WELDON GLICK LPCP
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6010 W OVERLAND RD
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City | BOISE
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State | ID
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Zip | 83709-3013
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Country | US
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Telephone | 208-377-5720
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Fax |
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Provider Business Mailing Address
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Address Line | 2860 E VICTORY RD
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City | MERIDIAN
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State | ID
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Zip | 83642-7051
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPCP3
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License Number State | ID
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