Provider Demographics
NPI:1932824109
Name:SANTILLANES, ANALISSA CAMACHO (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:ANALISSA
Middle Name:CAMACHO
Last Name:SANTILLANES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:ANALISSA
Other - Middle Name:CAMACHO
Other - Last Name:SANTILLANES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5483 JOSH AVE
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5098
Mailing Address - Country:US
Mailing Address - Phone:208-637-5213
Mailing Address - Fax:
Practice Address - Street 1:1800 GARRETT WAY STE 47
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5132
Practice Address - Country:US
Practice Address - Phone:801-564-4479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-446601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical