Provider Demographics
NPI:1942923248
Name:LARA, GAILIA ANN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:GAILIA
Middle Name:ANN
Last Name:LARA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:GAILIA
Other - Middle Name:ANN
Other - Last Name:BEGAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-1105
Mailing Address - Country:US
Mailing Address - Phone:208-219-2263
Mailing Address - Fax:
Practice Address - Street 1:1309 BENNETT AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2676
Practice Address - Country:US
Practice Address - Phone:208-678-7796
Practice Address - Fax:208-678-7799
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLSMW-42686390200000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program