Provider Demographics
NPI:1013447671
Name:SEVERNS, JOSHUA MICHAEL (LCSW, ACADC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:MICHAEL
Last Name:SEVERNS
Suffix:
Gender:M
Credentials:LCSW, ACADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:PLUMMER
Mailing Address - State:ID
Mailing Address - Zip Code:83851-0388
Mailing Address - Country:US
Mailing Address - Phone:208-686-1449
Mailing Address - Fax:208-686-5133
Practice Address - Street 1:427 N 12TH STREET
Practice Address - Street 2:
Practice Address - City:PLUMMER
Practice Address - State:ID
Practice Address - Zip Code:83851
Practice Address - Country:US
Practice Address - Phone:208-686-1449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACADC-13016101YA0400X
IDLMSW-36753101YA0400X
IDLCSW-39053101YA0400X, 171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator