Provider Demographics
NPI:1912185968
Name:METTLER, ROSA ANJELICA (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:ANJELICA
Last Name:METTLER
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 1:950 W IRONWOOD DR STE 6
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2644
Mailing Address - Country:US
Mailing Address - Phone:208-704-5401
Mailing Address - Fax:208-664-8681
Practice Address - Street 1:950 W IRONWOOD DR STE 6
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2644
Practice Address - Country:US
Practice Address - Phone:208-704-5401
Practice Address - Fax:208-664-8681
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IDLCSW34821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker