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1002 Shoshone St E Twin Falls ID 83301-6338 | |
| (208) 734-7714 | |
| (208) 735-8537 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1002 Shoshone St E, Twin Falls, Idaho |
| Authorized Official Name and Position | Evelyn Mallea (OWNER) |
| Authorized Official Contact | 2087347714 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1002 Shoshone St E Twin Falls ID 83301-6338 Ph: (208) 734-7714 | 1002 Shoshone St E Twin Falls ID 83301-6338 Ph: (208) 734-7714 |
| NPI Number | 1770671372 |
|---|---|
| Provider Enumeration Date | 10/10/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770671372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW779 (Idaho) | Primary |
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