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General NPI Number Information
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NPI Number | 1376346411
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Entity Type | Individual
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Provider Name | KAITLYN DREW BISHARAT LPC
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Gender | Female
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 495 EMERALD AVE
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City | BLACKFOOT
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State | ID
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Zip | 83221-3968
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Country | US
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Telephone | 208-932-4545
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Fax | 208-881-9038
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Provider Business Mailing Address
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Address Line | 62 S 1200 W
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City | BLACKFOOT
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State | ID
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Zip | 83221-6075
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Country | US
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Telephone | 208-681-7309
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6861160
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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 | 6861160
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6861160
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License Number State | ID
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