Healthcare Provider Details

I. General information

NPI: 1508159880
Provider Name (Legal Business Name): KRISTI L WEISMANN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2589 S FIVE MILE RD
BOISE ID
83709-2325
US

IV. Provider business mailing address

2589 S FIVE MILE RD
BOISE ID
83709-2325
US

V. Phone/Fax

Practice location:
  • Phone: 208-917-2540
  • Fax: 208-908-6404
Mailing address:
  • Phone: 208-917-2540
  • Fax: 208-908-6404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC5334
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: