Individual
PRISCILLA SHARON-GEORGIA BAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1450 AVIATION DR, HAILEY, ID 83333-8785
(208) 727-8970
(208) 727-8979
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LMSW-42222
ID
104100000X
Social Worker
LMSW-42222
ID
104100000X
Social Worker
LSW-40865
ID
1041C0700X
Clinical Social Worker
Primary
8861956
ID
Other
Enumeration date
04/07/2022
Last updated
12/03/2024
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