Provider Demographics
NPI:1790163285
Name:BUCHHOLZ, REBECCA (M ED, ACADC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:M ED, ACADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N BENJAMIN LN
Mailing Address - Street 2:SUITE #201
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5094
Mailing Address - Country:US
Mailing Address - Phone:208-577-4887
Mailing Address - Fax:
Practice Address - Street 1:400 N BENJAMIN LN
Practice Address - Street 2:SUITE #201
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5094
Practice Address - Country:US
Practice Address - Phone:208-577-4887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID164101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)