MEDICARE: ANDREA SUZANNE HIGGINS LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	8722	ID

General Provider Information

NPI Number	:	1861139834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SUZANNE HIGGINS LCPC

Provider Business Mailing Address
First Line	:	1901 N 23RD ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-0520
Country	:	US
Telephone Number	:	713-320-4349
Fax Number	:

Provider Business Practice Location Address
First Line	:	4477 W EMERALD ST STE C225
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-2076
Country	:	US
Telephone Number	:	713-320-4349
Fax Number	:	208-318-0218

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2022
Last Update Date	:	05/19/2022

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