Healthcare Provider Details

I. General information

NPI: 1598351553
Provider Name (Legal Business Name): CARLY C BAILEY NEFF LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 E STATE AVE
MERIDIAN ID
83642-8808
US

IV. Provider business mailing address

1650 S TOPAZ WAY
MERIDIAN ID
83642-4474
US

V. Phone/Fax

Practice location:
  • Phone: 208-672-1801
  • Fax:
Mailing address:
  • Phone: 208-605-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW-28504
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: