Healthcare Provider Details

I. General information

NPI: 1144094939
Provider Name (Legal Business Name): GILLIAN SHEFFIELD SCOVILLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 NORTHWEST BLVD STE C
COEUR D ALENE ID
83814-2114
US

IV. Provider business mailing address

211 E WALLACE AVE APT 3
COEUR D ALENE ID
83814-2983
US

V. Phone/Fax

Practice location:
  • Phone: 208-930-1740
  • Fax:
Mailing address:
  • Phone: 719-306-5003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7081330
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: