Healthcare Provider Details

I. General information

NPI: 1548999410
Provider Name (Legal Business Name): HEATHER LOUISE CARRIZALES LMSW, ADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 S 9TH AVE STE 103
CALDWELL ID
83605-5072
US

IV. Provider business mailing address

2607 S MONTANA AVE
CALDWELL ID
83605-5722
US

V. Phone/Fax

Practice location:
  • Phone: 208-854-9758
  • Fax:
Mailing address:
  • Phone: 208-854-9758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4581403
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC-5032
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: