Healthcare Provider Details

I. General information

NPI: 1174768345
Provider Name (Legal Business Name): WENDI MCCUTCHEN ADAMS LCPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23423 OLD HIGHWAY 30
CALDWELL ID
83607
US

IV. Provider business mailing address

23423 OLD HIGHWAY 30
CALDWELL ID
83607
US

V. Phone/Fax

Practice location:
  • Phone: 208-353-6147
  • Fax: 866-722-6557
Mailing address:
  • Phone: 208-353-6147
  • Fax: 866-722-6557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10280000
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC-5830
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: