Healthcare Provider Details

I. General information

NPI: 1033983192
Provider Name (Legal Business Name): MISTY BESCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W HANLEY AVE STE 101
COEUR D ALENE ID
83815-8994
US

IV. Provider business mailing address

509 W HANLEY AVE STE 101
COEUR D ALENE ID
83815-8994
US

V. Phone/Fax

Practice location:
  • Phone: 253-318-1688
  • Fax:
Mailing address:
  • Phone: 253-318-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-8861801
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: