Individual
MILDRED AZUCENA GAITAN-GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
160 MAIN AVE N, TWIN FALLS, ID 83301-6101
(208) 733-3024
(208) 733-0929
Mailing address
160 MAIN AVE N, TWIN FALLS, ID 83301-6101
(208) 733-3024
(208) 733-0929
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW-32352
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-34217
ID
Other
Enumeration date
12/11/2012
Last updated
10/25/2021
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