Provider Demographics
NPI:1265874184
Name:NEIGHBORS, ALAN GLEN (LCSW)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:GLEN
Last Name:NEIGHBORS
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 1:1025 S BRIDGEWAY PL STE 280
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6834
Mailing Address - Country:US
Mailing Address - Phone:208-412-7762
Mailing Address - Fax:208-853-1318
Practice Address - Street 1:1025 S BRIDGEWAY PL STE 280
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6834
Practice Address - Country:US
Practice Address - Phone:208-412-7740
Practice Address - Fax:208-853-1318
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA331511041C0700X
ID365311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical