Active NPI
Lylena Marie Self, LCSW
- Case Manager/Care Coordinator
- Boise, ID
National Provider Identifier
1295093789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- LCSW30738
- Practice address
- 1720 N Westgate Dr Ste 1a
Boise, ID 83704-7164 - Phone
- (208) 334-6938
- Fax
- (208) 334-0812
- NPI assigned
- May 2, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | LCSW30738 | ID | Primary |
Addresses
Primary practice location
1720 N Westgate Dr Ste 1a
Boise, ID 83704-7164
Mailing address
1720 N Westgate Dr Ste 1a
Boise, ID 83704-7164
Phone (208) 334-6938
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LCSW-30738 | Other | ID | BUREAU OF OCCUPATIONAL LICENSES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW30738 | ID | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335916800000",
"number": "1295093789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1720 N WESTGATE DR STE 1A",
"city": "BOISE",
"state": "ID",
"postal_code": "837047164",
"telephone_number": "208-334-6938",
"fax_number": "208-334-0812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1720 N WESTGATE DR STE 1A",
"city": "BOISE",
"state": "ID",
"postal_code": "837047164",
"telephone_number": "208-334-6938",
"fax_number": "208-334-0812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELF",
"first_name": "LYLENA",
"middle_name": "MARIE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-02",
"last_updated": "2012-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "ID",
"license": "LCSW30738",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BUREAU OF OCCUPATIONAL LICENSES",
"identifier": "LCSW-30738",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.