Individual
KEISHA HARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3525 E LOUISE DR, MERIDIAN, ID 83642-6302
(208) 994-1934
(208) 706-7059
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
31456
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-36372
ID
Other
Enumeration date
03/07/2016
Last updated
10/05/2018
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