Healthcare Provider Details

I. General information

NPI: 1275478059
Provider Name (Legal Business Name): MINDY THACKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINDY JONES

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S THIRD AVE STE 1
SANDPOINT ID
83864-1358
US

IV. Provider business mailing address

211 E COEUR D'ALENE AVE STE 102
COEUR D'ALENE ID
83814
US

V. Phone/Fax

Practice location:
  • Phone: 208-691-4687
  • Fax: 208-620-2306
Mailing address:
  • Phone: 208-699-6817
  • Fax: 208-620-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9061679
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: