Provider Demographics
NPI:1619732666
Name:OAKES, ALICIA (LMSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:OAKES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 E 25TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7523
Mailing Address - Country:US
Mailing Address - Phone:208-569-6450
Mailing Address - Fax:
Practice Address - Street 1:2235 E 25TH ST STE 200
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7523
Practice Address - Country:US
Practice Address - Phone:208-569-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health