Healthcare Provider Details

I. General information

NPI: 1104691674
Provider Name (Legal Business Name): LAITEN ASHLEY CARR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 N LAKEHARBOR LN
BOISE ID
83703-6913
US

IV. Provider business mailing address

3663 N LAKEHARBOR LN
BOISE ID
83703-6913
US

V. Phone/Fax

Practice location:
  • Phone: 208-286-4274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number43902
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: