Provider Demographics
NPI:1053718015
Name:ROMRELL, ERIC (LMSW)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:ROMRELL
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 1:1565 E LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-2129
Mailing Address - Country:US
Mailing Address - Phone:208-524-8996
Mailing Address - Fax:208-524-1205
Practice Address - Street 1:1565 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-2129
Practice Address - Country:US
Practice Address - Phone:208-524-8996
Practice Address - Fax:208-524-1205
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-295521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical