Provider Demographics
NPI:1932357787
Name:MCDOUGALL, ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MCDOUGALL
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 1:5217 CROSSBOW WAY
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-1867
Mailing Address - Country:US
Mailing Address - Phone:208-453-8936
Mailing Address - Fax:
Practice Address - Street 1:2922 CLEVELAND BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4436
Practice Address - Country:US
Practice Address - Phone:208-453-1439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW292691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806560800Medicaid
ID806560800Medicaid