Healthcare Provider Details

I. General information

NPI: 1508159880
Provider Name (Legal Business Name): KRISTI L WEISMANN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 E GOLDSTONE DR
MERIDIAN ID
83642-1549
US

IV. Provider business mailing address

3006 E GOLDSTONE DR
MERIDIAN ID
83642-1549
US

V. Phone/Fax

Practice location:
  • Phone: 208-917-2540
  • Fax: 208-908-6164
Mailing address:
  • Phone: 208-917-2540
  • Fax: 208-908-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC5334
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: