Provider Demographics
NPI:1518492354
Name:JUSTINE SWEET, LCSW, LLC
Entity Type:Organization
Organization Name:JUSTINE SWEET, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-316-9438
Mailing Address - Street 1:1525 ADDISON AVE E
Mailing Address - Street 2:D4
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5300
Mailing Address - Country:US
Mailing Address - Phone:208-316-9438
Mailing Address - Fax:
Practice Address - Street 1:510 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6210
Practice Address - Country:US
Practice Address - Phone:208-316-9438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1316228976Medicaid