Healthcare Provider Details

I. General information

NPI: 1194339176
Provider Name (Legal Business Name): ALFREDO MEJIA LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 W OVERLAND RD OFC 101
MERIDIAN ID
83642-6541
US

IV. Provider business mailing address

4511 N TEMPEST WAY
MERIDIAN ID
83646-3767
US

V. Phone/Fax

Practice location:
  • Phone: 986-204-8411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-4538
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: