Provider Demographics
NPI:1619728987
Name:BOST, TED ROBY III (LPC)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:ROBY
Last Name:BOST
Suffix:III
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 1:5001 CHERRY GULCH LN
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-5123
Mailing Address - Country:US
Mailing Address - Phone:208-365-3437
Mailing Address - Fax:
Practice Address - Street 1:5001 CHERRY GULCH LN
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-5123
Practice Address - Country:US
Practice Address - Phone:208-365-3437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health