Provider Demographics
NPI:1144591934
Name:SMITH, EMILY RICKS (LCSW-34678)
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:RICKS
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW-34678
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2267 TETON PLZ
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6486
Mailing Address - Country:US
Mailing Address - Phone:208-522-0140
Mailing Address - Fax:208-524-7335
Practice Address - Street 1:2267 TETON PLZ
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6486
Practice Address - Country:US
Practice Address - Phone:208-529-1660
Practice Address - Fax:208-524-7335
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW346781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0056-0197374Medicaid