Healthcare Provider Details

I. General information

NPI: 1417474859
Provider Name (Legal Business Name): NEW BEGINNINGS COUNSELING AND SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 IDAHO ST
LEWISTON ID
83501-1938
US

IV. Provider business mailing address

1002 IDAHO ST
LEWISTON ID
83501-1938
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLMSW36870
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberLMSW36870
License Number StateID

VIII. Authorized Official

Name: STEPHANIE LE ANNE BEIDMAN
Title or Position: OWNER
Credential: LMSW
Phone: 208-746-7661