Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Bo Robert Smith

Individual provider Mental Health Counselor · NPI 1104623784

Mr. Bo Robert Smith is a Mental Health Counselor in Blackfoot, Idaho. Qualified in 2025, 1 year ago. Practices as a sole proprietor. Licensed in Idaho.

Years since qualifying
1
Licensed in
ID
In the registry since
2025
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Practice location Address checks out

1309 Camas St
Blackfoot, ID 83221-3060
Phone: (208) 782-0675
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence 3071150 (ID)

Record details

NPI number1104623784
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedFebruary 28, 2025
Last updated in NPPESFebruary 28, 2025
Certification dateFebruary 28, 2025
Mailing address297 Pendlebury Ln Apt 1, Blackfoot, ID 83221-2815

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Blackfoot