Provider Demographics
NPI:1093036147
Name:LEIFHEIT, JUD EUGENE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JUD
Middle Name:EUGENE
Last Name:LEIFHEIT
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 1:1110 W PARK PL STE 305
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2784
Mailing Address - Country:US
Mailing Address - Phone:208-667-6606
Mailing Address - Fax:208-765-3051
Practice Address - Street 1:1110 W PARK PL STE 305
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2784
Practice Address - Country:US
Practice Address - Phone:208-667-6606
Practice Address - Fax:208-765-3051
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-294911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1093036147Medicaid