Provider Demographics
NPI:1437317989
Name:POWELL, ALICIA FLYNNE (MSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:FLYNNE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:FLYNNE
Other - Last Name:KARLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:916 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-5013
Mailing Address - Country:US
Mailing Address - Phone:208-305-5570
Mailing Address - Fax:
Practice Address - Street 1:916 CEDAR DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-5013
Practice Address - Country:US
Practice Address - Phone:208-305-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALMHC101YM0800X
WALH00004247101YM0800X
WALICSW-600413361041C0700X
IDLCSW-259101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health