Provider Demographics
NPI:1982004123
Name:DAVIES, BRIAN S (LCPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:S
Last Name:DAVIES
Suffix:
Gender:M
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 W FORT ST
Mailing Address - Street 2:APT. 3
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5374
Mailing Address - Country:US
Mailing Address - Phone:208-850-9696
Mailing Address - Fax:
Practice Address - Street 1:1529 BELMONT ST.
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-391-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7619101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional