Provider Demographics
NPI:1376823740
Name:PERSONAL DEVELOPMENT
Entity Type:Organization
Organization Name:PERSONAL DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWOPE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-375-0752
Mailing Address - Street 1:8100 W EMERALD ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9055
Mailing Address - Country:US
Mailing Address - Phone:208-375-0752
Mailing Address - Fax:208-375-0796
Practice Address - Street 1:232 2ND ST S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3709
Practice Address - Country:US
Practice Address - Phone:208-453-8915
Practice Address - Fax:208-453-8937
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFINITY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health