Healthcare Provider Details

I. General information

NPI: 1598317919
Provider Name (Legal Business Name): OLGA ESQUIVEL LIRA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 EASTLAND DR
TWIN FALLS ID
83301-6858
US

IV. Provider business mailing address

794 EASTLAND DR
TWIN FALLS ID
83301-6856
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-1281
  • Fax:
Mailing address:
  • Phone: 208-734-1281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW44172
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: