Healthcare Provider Details

I. General information

NPI: 1801656269
Provider Name (Legal Business Name): MAKAYLA SUNDQUIST LPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 SANDPOINT WEST DR
SANDPOINT ID
83864-7304
US

IV. Provider business mailing address

PO BOX 166
KOOTENAI ID
83840-0166
US

V. Phone/Fax

Practice location:
  • Phone: 208-265-5412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10210
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-10210
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: