Provider Demographics
NPI:1235437591
Name:SLAVEN, WILLIAM C (LCSW, CADC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:SLAVEN
Suffix:
Gender:M
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 W LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2306
Mailing Address - Country:US
Mailing Address - Phone:208-237-3365
Mailing Address - Fax:208-232-5423
Practice Address - Street 1:1135 YELLOWSTONE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5082
Practice Address - Country:US
Practice Address - Phone:208-237-3365
Practice Address - Fax:208-232-5423
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 280161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical