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General NPI Number Information
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NPI Number | 1225531163
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Entity Type | Individual
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Provider Name | MYJA AMELIA MAKI LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 7291 W FRANKLIN RD
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City | BOISE
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State | ID
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Zip | 83709-0926
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Country | US
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Telephone | 208-323-4400
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Fax | 208-810-4090
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Provider Business Mailing Address
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Address Line | 3778 N 39TH ST
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City | BOISE
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State | ID
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Zip | 83703-4514
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Country | US
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Telephone | 208-861-1050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-41345
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License Number State | ID
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