Healthcare Provider Details

I. General information

NPI: 1942123880
Provider Name (Legal Business Name): ERIC JONN CHAMPLIN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 E PINE AVE
MERIDIAN ID
83642-5995
US

IV. Provider business mailing address

3000 E PINE AVE
MERIDIAN ID
83642-5995
US

V. Phone/Fax

Practice location:
  • Phone: 986-224-3282
  • Fax:
Mailing address:
  • Phone: 986-224-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-35738
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: