Provider Demographics
NPI:1861667842
Name:BECIROVIC, LEJLA (MSW)
Entity Type:Individual
Prefix:
First Name:LEJLA
Middle Name:
Last Name:BECIROVIC
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 11TH AVE E
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-5368
Mailing Address - Country:US
Mailing Address - Phone:208-934-8461
Mailing Address - Fax:
Practice Address - Street 1:762 FALLS AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3316
Practice Address - Country:US
Practice Address - Phone:208-734-4200
Practice Address - Fax:208-734-1404
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical