Healthcare Provider Details

I. General information

NPI: 1467363028
Provider Name (Legal Business Name): MARGO HARUMI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N 7TH AVE STE 135
POCATELLO ID
83201-5790
US

IV. Provider business mailing address

500 S 11TH AVE STE 400
POCATELLO ID
83201-4880
US

V. Phone/Fax

Practice location:
  • Phone: 208-232-7862
  • Fax:
Mailing address:
  • Phone: 208-232-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2471361
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: