Healthcare Provider Details

I. General information

NPI: 1710088984
Provider Name (Legal Business Name): DEBORAH LEWIS MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 HILINE RD 210
POCATELLO ID
83201-2947
US

IV. Provider business mailing address

2420 E 25TH ST
IDAHO FALLS ID
83404-7549
US

V. Phone/Fax

Practice location:
  • Phone: 208-478-9081
  • Fax: 208-478-4999
Mailing address:
  • Phone: 208-542-1026
  • Fax: 208-528-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMSW-26974
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: