Healthcare Provider Details

I. General information

NPI: 1982786448
Provider Name (Legal Business Name): V. GINNA MAUS LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 N THIRD AVE STE 201
SANDPOINT ID
83864-1423
US

IV. Provider business mailing address

231 N THIRD AVE STE 201
SANDPOINT ID
83864-1423
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-8948
  • Fax: 208-265-1779
Mailing address:
  • Phone: 208-263-8948
  • Fax: 208-265-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GINNA MINERVINI
Title or Position: OWNER / PSYCHOTHERAPIST
Credential: LCSW
Phone: 208-263-8948