Provider Demographics
NPI:1104558337
Name:ARZOLA, JOSE LUIS JR (LMSW)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:ARZOLA
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 W LONG MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-5048
Mailing Address - Country:US
Mailing Address - Phone:208-406-6565
Mailing Address - Fax:
Practice Address - Street 1:4417 W LONG MEADOW DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-5048
Practice Address - Country:US
Practice Address - Phone:208-406-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID42384101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health