Individual provider · Type 1 NPI
Randy Wild, LCPC
Mental Health Counselor · Boise, ID
NPI number
1295939080
Active
Practice location
3152 S Bown Way Ste 103
Boise, ID 83706-5456
Fax (541) 550-7941
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Counselor Primary | 101YM0800X | C1740 (OR) |
Mental Health Counselor: Definition to come...
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About NPI 1295939080
Randy Wild, LCPC's National Provider Identifier is 1295939080, issued on Jun 13, 2007. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Boise, ID. The record was last updated on Feb 14, 2024.