Wilde, Brandon J

Wilde, Brandon J is an sole proprietor health care provider with primary practice located at 4460 Central Way Suite 2, Chubbuck ID 83202. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Wilde, Brandon J can be contacted via phone (208) 237-1711.

Contact Information

Primary practice address
4460 Central Way Suite 2 Chubbuck ID 83202
Phone: (208) 237-1711
Fax: (208) 237-5192
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 9471002-6004 Utah
Behavioral Health & Social Service Providers / Mental Health 101YM0800X LPC3887 Idaho

Profile Details

NPI number 1710140447
LBN Legal business name Wilde, Brandon J
Credentials CMHC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 2nd, 2008
Last updated Jun 2nd, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710140447 NPPES
Idaho MEDICAID 807197600

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