Healthcare Provider Details

I. General information

NPI: 1457195844
Provider Name (Legal Business Name): CODY SOHN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 E GOLDSTONE DR
MERIDIAN ID
83642-1549
US

IV. Provider business mailing address

4648 SAGE CREEK DR
BOISE ID
83714-5507
US

V. Phone/Fax

Practice location:
  • Phone: 303-588-6477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: