Basic Information
| Provider Information | |||||||||
| NPI: | 1487851234 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARFORD | ||||||||
| FirstName: | ERROL | ||||||||
| MiddleName: | HERMAN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 518 BANK ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | WALLACE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838732225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085560960 | ||||||||
| FaxNumber: | 2085560970 | ||||||||
| Practice Location | |||||||||
| Address1: | 518 BANK ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | WALLACE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838732225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085560960 | ||||||||
| FaxNumber: | 2085560970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LCSW24896 | ID | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 000010144544 | 01 | ID | REGENCE BLUESHIELD | OTHER | L2821 | 01 | ID | BLUECROSS OF IDAHO | OTHER |