Provider Demographics
NPI:1295198240
Name:DAVE LIDDLE & ASSOCIATES
Entity Type:Organization
Organization Name:DAVE LIDDLE & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:SALISBURY
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:208-424-3189
Mailing Address - Street 1:600 N CURTIS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1449
Mailing Address - Country:US
Mailing Address - Phone:208-424-3189
Mailing Address - Fax:208-424-0133
Practice Address - Street 1:600 N CURTIS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1449
Practice Address - Country:US
Practice Address - Phone:208-424-3189
Practice Address - Fax:208-424-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty