Healthcare Provider Details

I. General information

NPI: 1265865554
Provider Name (Legal Business Name): DAVID RONALD PRIESTLEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S 1ST W
PRESTON ID
83263-1204
US

IV. Provider business mailing address

PO BOX 54
FRANKLIN ID
83237-0054
US

V. Phone/Fax

Practice location:
  • Phone: 208-852-2370
  • Fax: 208-852-5570
Mailing address:
  • Phone: 208-852-2370
  • Fax: 208-852-5570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-30965
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: