Provider Demographics
NPI:1619241387
Name:WEEKS, BETTY J (LCSW)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:WEEKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 SAINT JOHNS WAY
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2436
Mailing Address - Country:US
Mailing Address - Phone:208-750-7462
Mailing Address - Fax:208-750-7467
Practice Address - Street 1:428 6TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2355
Practice Address - Country:US
Practice Address - Phone:208-799-6500
Practice Address - Fax:208-799-6504
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 171M00000X
IDLMSW-30973104100000X
IDLCSW-362301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator