Provider Demographics
NPI:1114405925
Name:PRICE, GARRETT (LPC)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17917 N EVANTON WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-5524
Mailing Address - Country:US
Mailing Address - Phone:208-409-8120
Mailing Address - Fax:
Practice Address - Street 1:17917 N EVANTON WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-5524
Practice Address - Country:US
Practice Address - Phone:208-409-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional