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General NPI Number Information
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NPI Number | 1851720197
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Entity Type | Individual
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Provider Name | VICTORIA L MECHAM LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 320 B ST STE 109
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3547
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Country | US
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Telephone | 208-528-5434
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Fax | 208-522-4364
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Provider Business Mailing Address
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Address Line | 118 S STOUT AVE
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City | BLACKFOOT
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State | ID
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Zip | 83221-2943
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Country | US
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Telephone | 208-785-5810
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Fax | 208-522-4364
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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-25042
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License Number State | ID
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