Healthcare Provider Details

I. General information

NPI: 1497133276
Provider Name (Legal Business Name): BRITTANY HEYREND LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 S BALTIC PL
MERIDIAN ID
83642-5935
US

IV. Provider business mailing address

82 S BALTIC PL
MERIDIAN ID
83642-5935
US

V. Phone/Fax

Practice location:
  • Phone: 208-391-5345
  • Fax:
Mailing address:
  • Phone: 208-391-5345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-5768
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: