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General NPI Number Information
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NPI Number | 1063248961
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Entity Type | Individual
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Provider Name | BIANCA BAGDON LPC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 2068 S EAGLE RD
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City | MERIDIAN
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State | ID
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Zip | 83642-6707
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Country | US
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Telephone | 208-340-1688
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Fax |
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Provider Business Mailing Address
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Address Line | 7537 E TOUSSAND DR
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City | NAMPA
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State | ID
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Zip | 83687-5630
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-7461174
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License Number State | ID
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