Healthcare Provider Details

I. General information

NPI: 1063248961
Provider Name (Legal Business Name): BIANCA BAGDON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 S EAGLE RD
MERIDIAN ID
83642-6707
US

IV. Provider business mailing address

7537 E TOUSSAND DR
NAMPA ID
83687-5630
US

V. Phone/Fax

Practice location:
  • Phone: 208-340-1688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-7461174
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: