Provider Demographics
NPI:1992426282
Name:DAY, MYLA (LMSW)
Entity type:Individual
Prefix:
First Name:MYLA
Middle Name:
Last Name:DAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 S 4TH AVE # B
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6546
Mailing Address - Country:US
Mailing Address - Phone:208-351-8703
Mailing Address - Fax:
Practice Address - Street 1:2520 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-1923
Practice Address - Country:US
Practice Address - Phone:208-233-5433
Practice Address - Fax:877-284-2783
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-42588104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker