Healthcare Provider Details

I. General information

NPI: 1821697749
Provider Name (Legal Business Name): ASHLEY WEISS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S COLE RD STE 204
BOISE ID
83709-0934
US

IV. Provider business mailing address

204 S COLE RD STE 204
BOISE ID
83709-0934
US

V. Phone/Fax

Practice location:
  • Phone: 208-994-3622
  • Fax:
Mailing address:
  • Phone: 208-994-3622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW-43561
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-43561
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: