Healthcare Provider Details

I. General information

NPI: 1396107421
Provider Name (Legal Business Name): LAURA THAYER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 F ST
LEWISTON ID
83501-1930
US

IV. Provider business mailing address

1118 F ST
LEWISTON ID
83501-1930
US

V. Phone/Fax

Practice location:
  • Phone: 208-799-4440
  • Fax: 208-799-5171
Mailing address:
  • Phone: 208-799-4440
  • Fax: 208-799-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8321207
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8321207
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: