Healthcare Provider Details

I. General information

NPI: 1811875198
Provider Name (Legal Business Name): SPENCER MATHEW HEINDEL LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 W ORCHARD AVE
NAMPA ID
83651-1878
US

IV. Provider business mailing address

1007 W ORCHARD AVE
NAMPA ID
83651-1878
US

V. Phone/Fax

Practice location:
  • Phone: 208-461-2838
  • Fax:
Mailing address:
  • Phone: 208-461-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6671172
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: