Provider Demographics
NPI:1134767791
Name:ROWBURY, ADAM DAVID (BS CADC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:DAVID
Last Name:ROWBURY
Suffix:
Gender:M
Credentials:BS CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LAND BANK ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-1809
Mailing Address - Country:US
Mailing Address - Phone:208-522-6155
Mailing Address - Fax:208-522-6156
Practice Address - Street 1:1020 LAND BANK ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-1809
Practice Address - Country:US
Practice Address - Phone:208-522-6155
Practice Address - Fax:208-522-6156
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID673OtherIDAHO BOARD OF ALCOHOL/DRUG COUNSELOR CERTIFICATION