Provider Demographics
NPI:1003407404
Name:HUNT, JOHN BRADFORD (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRADFORD
Last Name:HUNT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 N NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3324
Mailing Address - Country:US
Mailing Address - Phone:208-549-9597
Mailing Address - Fax:
Practice Address - Street 1:202 N 9TH ST STE 201C
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5747
Practice Address - Country:US
Practice Address - Phone:208-549-9597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-44891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical