Healthcare Provider Details

I. General information

NPI: 1417092412
Provider Name (Legal Business Name): HILDING E OHRSTROM JR. LCPC, ACADC, CCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 N DIVISION AVE STE 104
SANDPOINT ID
83864-5054
US

IV. Provider business mailing address

PO BOX 572
PRIEST RIVER ID
83856-0572
US

V. Phone/Fax

Practice location:
  • Phone: 208-370-2010
  • Fax: 208-370-2011
Mailing address:
  • Phone: 208-370-2010
  • Fax: 208-370-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC-3830
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: