Provider Demographics
NPI:1982046173
Name:WINEGAR, ALVIN LLOYD JR (LMSW)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:LLOYD
Last Name:WINEGAR
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N 2ND E
Mailing Address - Street 2:SUITE 128
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1600
Mailing Address - Country:US
Mailing Address - Phone:208-709-6257
Mailing Address - Fax:208-356-5675
Practice Address - Street 1:310 N 2ND E
Practice Address - Street 2:SUITE 128
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1600
Practice Address - Country:US
Practice Address - Phone:208-709-6257
Practice Address - Fax:208-356-5675
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-31995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health