Healthcare Provider Details

I. General information

NPI: 1932759404
Provider Name (Legal Business Name): STEPHANIE LE ANNE BEIDMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 G ST
LEWISTON ID
83501-1934
US

IV. Provider business mailing address

800 MAIN ST # 11
LEWISTON ID
83501-1838
US

V. Phone/Fax

Practice location:
  • Phone: 509-254-3151
  • Fax:
Mailing address:
  • Phone: 208-746-7661
  • Fax: 208-746-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW36870
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-42227
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLMSW36870
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLMSW36870
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: