Healthcare Provider Details

I. General information

NPI: 1598404345
Provider Name (Legal Business Name): MICHELE HARMON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 JENNIE LEE DR
IDAHO FALLS ID
83404-6159
US

IV. Provider business mailing address

3562 E 630 N
MENAN ID
83434-5069
US

V. Phone/Fax

Practice location:
  • Phone: 208-932-7048
  • Fax:
Mailing address:
  • Phone: 208-390-6852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-8911032
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: