Provider Demographics
NPI:1003826405
Name:BODE, JOSHUA CHARLES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:CHARLES
Last Name:BODE
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 1:5647 W LUCKY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3141
Mailing Address - Country:US
Mailing Address - Phone:208-921-7190
Mailing Address - Fax:
Practice Address - Street 1:300 W MAIN ST STE 151
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7728
Practice Address - Country:US
Practice Address - Phone:208-921-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-26553104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker