Healthcare Provider Details

I. General information

NPI: 1043732274
Provider Name (Legal Business Name): ELIZABETH R HARDING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 S WOODRUFF AVE
IDAHO FALLS ID
83401-5596
US

IV. Provider business mailing address

2184 CHANNING WAY # 266
IDAHO FALLS ID
83404-8034
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-5450
  • Fax: 385-225-9327
Mailing address:
  • Phone: 208-557-1418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14007990-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC24363
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-41012
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: