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NPI Code Detail

MEDICARE: MRS. MYJA AMELIA MAKI LMSW

MEDICARE: MRS. MYJA AMELIA MAKI LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCSW-41345ID

General Provider Information

NPI Number : 1225531163
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MYJA AMELIA MAKI LMSW
Provider Business Mailing Address
First Line : 3778 N 39TH ST
Second Line :
City : BOISE
State : ID
Zip : 83703-4514
Country : US
Telephone Number : 208-861-1050
Fax Number :
Provider Business Practice Location Address
First Line : 7291 W FRANKLIN RD
Second Line :
City : BOISE
State : ID
Zip : 83709-0926
Country : US
Telephone Number : 208-323-4400
Fax Number : 208-810-4090
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2018
Last Update Date : 06/12/2025

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