Provider Demographics
NPI:1093024622
Name:PRICE, DUSTIN S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:S
Last Name:PRICE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5092 THURSTON ST
Mailing Address - Street 2:
Mailing Address - City:CHUBBOCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2116
Mailing Address - Country:US
Mailing Address - Phone:208-339-4728
Mailing Address - Fax:
Practice Address - Street 1:5092 THURSTON ST
Practice Address - Street 2:
Practice Address - City:CHUBBOCK
Practice Address - State:ID
Practice Address - Zip Code:83202-2116
Practice Address - Country:US
Practice Address - Phone:208-339-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical