Provider Demographics
NPI:1285443267
Name:CARRANZA, URIEL ALEJANDRO (LMSW)
Entity type:Individual
Prefix:
First Name:URIEL
Middle Name:ALEJANDRO
Last Name:CARRANZA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-3703
Mailing Address - Country:US
Mailing Address - Phone:208-716-6441
Mailing Address - Fax:208-542-5152
Practice Address - Street 1:560 3RD ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-3953
Practice Address - Country:US
Practice Address - Phone:208-529-0169
Practice Address - Fax:208-542-5152
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-40535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health