Provider Demographics
NPI:1295093573
Name:HORRAS, DAVID (MA, LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:HORRAS
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1930
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-1930
Mailing Address - Country:US
Mailing Address - Phone:208-301-5115
Mailing Address - Fax:
Practice Address - Street 1:1276 W RIVER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7066
Practice Address - Country:US
Practice Address - Phone:208-338-4699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4759101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor