Gary D Edson, CADC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Boise, ID
NPI 1275688012 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1275688012
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 53 (ID)
- Practice address
- 1055 N Curtis Rd
Boise, ID 83706-1309 - Phone
- (208) 367-3069
- Fax
- (208) 367-3002
- NPI assigned
- Jan 24, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53 | ID | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 53 | ID | Yes |
Addresses
Primary practice location
1055 N Curtis Rd
Boise, ID 83706-1309
Mailing address
PO Box 190930
Boise, ID 83719-0930
Phone (208) 367-3069
Other providers in Boise, ID
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- Mark L Edlefsen
- Kaitlin Edminsten
- Carrie Ann Edmonds
- Jessica Ellen Edmunds
- Cynthia Edstrom
- Noah Blue Edvalson
- Olivia Edvalson
- Edward H Newcombe
- Amy S Edwards
All providers in Boise, ID · Addiction (Substance Use Disorder) Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.