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NPI Code Detail

MEDICARE: ERIN BRYANT LCSW

MEDICARE: ERIN BRYANT LCSW
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 Worker
2104100000XSocial WorkerLCSW-39201ID

General Provider Information

NPI Number : 1699197657
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN BRYANT LCSW
Provider Business Mailing Address
First Line : 12103 W EVELY PINES LN
Second Line :
City : STAR
State : ID
Zip : 83669-6126
Country : US
Telephone Number : 208-515-0185
Fax Number :
Provider Business Practice Location Address
First Line : 417 S 6TH ST
Second Line :
City : BOISE
State : ID
Zip : 83702-7632
Country : US
Telephone Number : 208-577-4468
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2014
Last Update Date : 06/27/2024

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