Phillip Hathaway, LMSW Valid NPI

Individual provider · Clinical Social Worker · Rexburg, ID

NPI

1316507296

Type

Individual (Type 1)

Primary specialty

Clinical Social Worker (Social Worker)

Specialty group

Behavioral Health & Social Service Providers

Taxonomy code

1041C0700X

License number

LMSW-38731 (ID)

Sex

Male

Sole proprietor

No

Enumerated

2019-06-13

Last updated

2019-06-13