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General NPI Number Information
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NPI Number | 1104903236
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Entity Type | Individual
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Provider Name | KIMBERLY LYNN HUDLET LCPC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 4700 N CLOVERDALE RD SUITE 214
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City | BOISE
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State | ID
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Zip | 83713-1081
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Country | US
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Telephone | 208-376-4819
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Fax | 866-305-0713
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Provider Business Mailing Address
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Address Line | 4700 N CLOVERDALE RD STE 214
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City | BOISE
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State | ID
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Zip | 83713-1068
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1063004
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC 2838
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License Number State | ID
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