Provider Demographics
NPI:1225397102
Name:WINEGAR, BETH (LMSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:WINEGAR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 N 1587 E
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445-5109
Mailing Address - Country:US
Mailing Address - Phone:208-624-0167
Mailing Address - Fax:208-359-9683
Practice Address - Street 1:218 DIVIDEND DR STE 3
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3510
Practice Address - Country:US
Practice Address - Phone:208-359-9683
Practice Address - Fax:208-359-9683
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-31996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health