Healthcare Provider Details

I. General information

NPI: 1043873789
Provider Name (Legal Business Name): ANGIE ZABALA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 OVERLAND AVE STE 5A
BURLEY ID
83318-2957
US

IV. Provider business mailing address

PO BOX 492
PAUL ID
83347-0492
US

V. Phone/Fax

Practice location:
  • Phone: 208-260-1883
  • Fax: 208-837-8322
Mailing address:
  • Phone: 208-260-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-38280
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-8861102
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: