Individual
CASEY MALIA VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
740 MCKINLEY AVE, KELLOGG, ID 83837-2693
(208) 783-1267
Mailing address
PO BOX 1387, HAYDEN, ID 83835-1387
(208) 415-0299
(208) 625-2070
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LMSW-36778
ID
104100000X
Social Worker
36778
ID
1041C0700X
Clinical Social Worker
Primary
40088
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36778
STATE LICENSE
ID
Enumeration date
06/27/2017
Last updated
10/05/2020
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