Healthcare Provider Details

I. General information

NPI: 1114539376
Provider Name (Legal Business Name): SYDNEY STEVENS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 N 4TH ST STE 201
COEUR D ALENE ID
83814-3100
US

IV. Provider business mailing address

1022 N 4TH ST STE 201
COEUR D ALENE ID
83814-3100
US

V. Phone/Fax

Practice location:
  • Phone: 208-449-6491
  • Fax: 208-450-2239
Mailing address:
  • Phone: 208-449-6491
  • Fax: 208-450-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC9247
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: