Individual
RAVAE MINTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
1373 FILLMORE ST, TWIN FALLS, ID 83301-3392
(208) 737-9999
(208) 736-4400
Mailing address
1373 FILLMORE ST, TWIN FALLS, ID 83301-3392
(208) 737-9999
(208) 736-4400
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-24889
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010148212
BLUE SHIELD
ID
01
—
L4280
BLUE CROSS
ID
Enumeration date
09/26/2006
Last updated
03/22/2016
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