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General NPI Number Information
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NPI Number | 1477439636
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Entity Type | Individual
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Provider Name | HEIDI LEE KOEPNICK LPC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 101 W 18TH ST
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City | BURLEY
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State | ID
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Zip | 83318-2422
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Country | US
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Telephone | 208-572-0074
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Fax |
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Provider Business Mailing Address
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Address Line | 23 W 200 S
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City | BURLEY
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State | ID
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Zip | 83318-6602
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Country | US
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Telephone | 208-219-4560
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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 | 6071260
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License Number State | ID
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