Malisa Williams, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-38838 Issued in ID

Practice address

1281 E Iron Eagle Dr
Eagle, ID 83616-6599

Phone

(208) 912-4011

NPI assigned

Apr 16, 2015

Last updated

Jan 29, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Malisa Moreland Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Renew Wellness LLC

  • Clinical Social Worker
  • Eagle, ID
  • NPI 1316538663
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611878400000",
    "number": "1184011124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5650 N DALSPRING AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131315",
            "telephone_number": "208-912-4011",
            "fax_number": "208-939-5535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1281 E IRON EAGLE DR",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166599",
            "telephone_number": "208-912-4011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1031 W Sanetta St",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836515047",
            "country_code": "US",
            "telephone_number": "208-466-7443",
            "fax_number": "208-466-5058",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MALISA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-16",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-38838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184011124",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "id.ambitions.org",
            "affiliation": "N",
            "address_1": "1031 W Sanetta St",
            "city": "Nampa",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836515047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MALISA",
            "last_name": "MORELAND",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Whole Hearted Counseling LLC
• Anthony Arthur Wilburn, LMT
• Wendi Wilch, LCPC
• Joshua Wilding, CADC
• Katie Elizabeth Williams, S.L.P
• Taylor N Williams, DPT LICENSE: PT-6769
• Sasha Windfield
• Emily R. Wolf, LMFT
• Bailey Wolfe
• Noreen A. Womack, MD

• Clinical Social Worker in Eagle, ID
• Providers in Eagle, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.