Basic Information
| Provider Information | |||||||||
| NPI: | 1043947211 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLAY SALMON LCSW LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2414 W PALOUSE ST | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837053543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082841011 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 W BANNOCK ST | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837025916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082841011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2022 | ||||||||
| LastUpdateDate: | 08/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | SALMON | ||||||||
| AuthorizedOfficialFirstName: | BRIANNA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2082841011 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 08/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.