Provider Demographics
NPI:1588949069
Name:MAY, ALICIA ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ELIZABETH
Last Name:MAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:ELIZABETH
Other - Last Name:MAY-SU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:17 12TH AVE S SUITE 207
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-6011
Mailing Address - Country:US
Mailing Address - Phone:208-649-4962
Mailing Address - Fax:
Practice Address - Street 1:17 12TH AVE S SUITE 207
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-6011
Practice Address - Country:US
Practice Address - Phone:208-649-4962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-34820101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1588949069Medicaid