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General NPI Number Information
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NPI Number | 1376300723
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Entity Type | Individual
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Provider Name | GABRIELLE ROSE MESSICK LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 4300 E. FLAMINGO AVE. CLINICAL RESOURCE MANAGEMENT
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City | 83687
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State | ID
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Zip | 83687
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Country | US
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Telephone | 208-590-6628
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Fax |
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Provider Business Mailing Address
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Address Line | 10944 ROCKY MOUNTAIN LN UNIT 102
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City | NAMPA
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State | ID
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Zip | 83687-4370
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Country | US
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Telephone | 208-565-8960
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44098
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License Number State | ID
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