Provider Demographics
NPI:1699315986
Name:TRAPP, KURT
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:TRAPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4963 W ALBION ST APT 104
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1290
Mailing Address - Country:US
Mailing Address - Phone:208-570-5239
Mailing Address - Fax:
Practice Address - Street 1:4963 W ALBION ST APT 104
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1290
Practice Address - Country:US
Practice Address - Phone:208-570-5239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician