Provider Demographics
NPI:1558137182
Name:TODD, CHANC NICOLE (LMSW)
Entity Type:Individual
Prefix:
First Name:CHANC
Middle Name:NICOLE
Last Name:TODD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CHANC
Other - Middle Name:NICOLE
Other - Last Name:ASHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11763 N 20TH WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-2033
Mailing Address - Country:US
Mailing Address - Phone:208-781-5078
Mailing Address - Fax:
Practice Address - Street 1:190 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6241
Practice Address - Country:US
Practice Address - Phone:208-781-5078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-39665104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker