Provider Demographics
NPI:1043799653
Name:MIRAHCIC, JOCELYN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:
Last Name:MIRAHCIC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:
Other - Last Name:SCHELSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2517 N RAPID CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-1688
Mailing Address - Country:US
Mailing Address - Phone:208-954-7791
Mailing Address - Fax:
Practice Address - Street 1:2517 N RAPID CREEK WAY
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-1688
Practice Address - Country:US
Practice Address - Phone:208-954-7791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-37792104100000X
ID411921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker