Provider Demographics
NPI:1659823292
Name:ALLUM, HEATHER (LCSW 38397)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ALLUM
Suffix:
Gender:F
Credentials:LCSW 38397
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10566 W IRVING CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8053
Mailing Address - Country:US
Mailing Address - Phone:208-585-4333
Mailing Address - Fax:
Practice Address - Street 1:1609 S KIMBALL AVE STE 201
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-5196
Practice Address - Country:US
Practice Address - Phone:208-585-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW38397101YM0800X, 101Y00000X, 103K00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID14500036OtherCAQH