Provider Demographics
NPI:1639587397
Name:ALVIM-TOLD, ELISA (LCSW)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:ALVIM-TOLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 W 1620 NORTH CIR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5313
Mailing Address - Country:US
Mailing Address - Phone:917-730-7789
Mailing Address - Fax:
Practice Address - Street 1:580 PERSHING ST STE 1
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-3053
Practice Address - Country:US
Practice Address - Phone:917-730-7789
Practice Address - Fax:970-367-1499
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99236371041C0700X
CO099236371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1127OtherNONE
CO52720586Medicaid