Provider Demographics
NPI:1992193866
Name:SEIDERS, JOSEPH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:SEIDERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S ORCHARD ST
Mailing Address - Street 2:SUITE 124A
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1260
Mailing Address - Country:US
Mailing Address - Phone:208-391-3849
Mailing Address - Fax:
Practice Address - Street 1:410 S ORCHARD ST
Practice Address - Street 2:SUITE 124A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1260
Practice Address - Country:US
Practice Address - Phone:208-391-3849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW355251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical