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General NPI Number Information
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NPI Number | 1194269688
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Entity Type | Individual
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Provider Name | ANGELA BAIRD HEPWORTH LPC
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Gender | Female
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 25612 KINGSBURY RD
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City | MIDDLETON
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State | ID
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Zip | 83644-5349
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Country | US
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Telephone | 208-870-2069
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Fax |
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Provider Business Mailing Address
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Address Line | 372 S EAGLE RD # 117
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City | EAGLE
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State | ID
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Zip | 83616-5908
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Country | US
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Telephone | 208-870-2069
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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 | 5850
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License Number State | ID
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