Healthcare Provider Details

I. General information

NPI: 1710815238
Provider Name (Legal Business Name): ALICIA COSIO LIPSCHULTZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E RIVERPARK LN STE 105
BOISE ID
83706-6561
US

IV. Provider business mailing address

3332 N SUMMERFIELD WAY
MERIDIAN ID
83646-5582
US

V. Phone/Fax

Practice location:
  • Phone: 208-830-6598
  • Fax:
Mailing address:
  • Phone: 530-400-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-9828
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: