Provider Demographics
NPI:1336477207
Name:BOARDMAN, RD (LPC)
Entity Type:Individual
Prefix:
First Name:RD
Middle Name:
Last Name:BOARDMAN
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:HEALTH SERVICES 1529 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83725-0001
Mailing Address - Country:US
Mailing Address - Phone:208-426-1459
Mailing Address - Fax:208-426-3005
Practice Address - Street 1:HEALTH SERVICES 1529 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83725-0001
Practice Address - Country:US
Practice Address - Phone:208-426-1459
Practice Address - Fax:208-426-3005
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY - 202708103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling