Healthcare Provider Details

I. General information

NPI: 1669939401
Provider Name (Legal Business Name): SUNGAH MCGARY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3456 E 17TH ST STE 270
AMMON ID
83406-6749
US

IV. Provider business mailing address

2750 PLOMMON ST
IDAHO FALLS ID
83402-5129
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-5450
  • Fax: 385-225-9327
Mailing address:
  • Phone: 801-631-9758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12874681-3502
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-44685
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: