Provider Demographics
NPI:1669515805
Name:MEUSBORN, COLENE K (LCSW, DCSW)
Entity type:Individual
Prefix:MRS
First Name:COLENE
Middle Name:K
Last Name:MEUSBORN
Suffix:
Gender:F
Credentials:LCSW, DCSW
Other - Prefix:
Other - First Name:COLENE
Other - Middle Name:K
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, DCSW
Mailing Address - Street 1:PO BOX 2306
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83206-2306
Mailing Address - Country:US
Mailing Address - Phone:208-478-8340
Mailing Address - Fax:208-478-8341
Practice Address - Street 1:335 N MAIN ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3108
Practice Address - Country:US
Practice Address - Phone:208-478-8340
Practice Address - Fax:208-478-8341
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-277791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical