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General NPI Number Information
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NPI Number | 1497318802
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Entity Type | Individual
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Provider Name | BILLYLYNN LEIUILANI HAN PESTELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 410 S ORCHARD ST STE 124
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City | BOISE
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State | ID
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Zip | 83705-1210
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Country | US
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Telephone | 208-398-0826
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Fax |
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Provider Business Mailing Address
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Address Line | 6692 W MORRIS HILL LN APT 103
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City | BOISE
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State | ID
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Zip | 83704-9282
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Country | US
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Telephone | 208-398-0826
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | BBH-LCSW-LIC-33967
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-43502
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License Number State | ID
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