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General NPI Number Information
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NPI Number | 1871828657
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Entity Type | Individual
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Provider Name | HEATHER L WILSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/12/2009
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 1103 W IRONWOOD DR STE A
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2604
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Country | US
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Telephone | 208-889-1355
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Fax | 208-625-2036
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Provider Business Mailing Address
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Address Line | 2484 W BETH LOOP
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City | POST FALLS
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State | ID
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Zip | 83854-5366
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Country | US
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Telephone | 208-889-1355
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Fax | 208-625-2036
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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 | 1431
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-5407
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC-5644
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License Number State | ID
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