Healthcare Provider Details

I. General information

NPI: 1053826701
Provider Name (Legal Business Name): ASHLEY C. BROWN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N 3RD ST STE 7
MCCALL ID
83638-4406
US

IV. Provider business mailing address

114 N 3RD ST STE 7
MCCALL ID
83638-4406
US

V. Phone/Fax

Practice location:
  • Phone: 208-462-0802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-39421
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: