Healthcare Provider Details

I. General information

NPI: 1821117664
Provider Name (Legal Business Name): LOUIS J PARRI CSWP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SKI HILL RD
DRIGGS ID
83422
US

IV. Provider business mailing address

PO BOX 1612
IDAHO FALLS ID
83403-1612
US

V. Phone/Fax

Practice location:
  • Phone: 208-354-3128
  • Fax: 208-354-3128
Mailing address:
  • Phone: 208-525-2090
  • Fax: 208-525-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSWP-468-C
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: