Provider Demographics
NPI:1528363819
Name:MCDOWELL, ELIZABETH M (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:150 SHOUP AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402
Mailing Address - Country:US
Mailing Address - Phone:208-528-5700
Mailing Address - Fax:208-528-5700
Practice Address - Street 1:2235 E 25TH ST
Practice Address - Street 2:SUITE 160
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7519
Practice Address - Country:US
Practice Address - Phone:208-528-9812
Practice Address - Fax:208-528-5747
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDLCSW301951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1881708832Medicaid