Healthcare Provider Details

I. General information

NPI: 1760071138
Provider Name (Legal Business Name): AMBER ALEXIS ROJAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 MORAN ST
IDAHO FALLS ID
83401-4337
US

IV. Provider business mailing address

5028 STANLEY DR
THE COLONY TX
75056-2032
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-0342
  • Fax:
Mailing address:
  • Phone: 208-716-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW-39076
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: