Healthcare Provider Details

I. General information

NPI: 1598480204
Provider Name (Legal Business Name): CHERI DENT LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 9TH AVE S STE A5
NAMPA ID
83651-3805
US

IV. Provider business mailing address

312 S BUTTERCUP CT
NAMPA ID
83687-8991
US

V. Phone/Fax

Practice location:
  • Phone: 208-614-1057
  • Fax:
Mailing address:
  • Phone: 208-250-4529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8331410
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8331410
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: