Provider Demographics
NPI:1730728080
Name:FRIDAY, LUCI RENEE
Entity type:Individual
Prefix:
First Name:LUCI
Middle Name:RENEE
Last Name:FRIDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RUSTLER CIR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-3458
Mailing Address - Country:US
Mailing Address - Phone:208-901-2880
Mailing Address - Fax:
Practice Address - Street 1:9 RUSTLER CIR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-3458
Practice Address - Country:US
Practice Address - Phone:208-901-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID193440012Medicaid