Healthcare Provider Details

I. General information

NPI: 1952856726
Provider Name (Legal Business Name): SPIAH CHARIAS PERZA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 NE 10TH AVE
PAYETTE ID
83661-5420
US

IV. Provider business mailing address

1441 NE 10TH AVE
PAYETTE ID
83661-5420
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-4760
  • Fax: 801-373-0639
Mailing address:
  • Phone: 208-642-9376
  • Fax: 208-642-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-39042
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL13349
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: