MEDICARE: HEIDY MEAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC-7814	ID

General Provider Information

NPI Number	:	1003439902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDY MEAD

Provider Business Mailing Address
First Line	:	PO BOX 192
Second Line	:
City	:	POLLOCK
State	:	ID
Zip	:	83547-0192
Country	:	US
Telephone Number	:	208-315-0993
Fax Number	:

Provider Business Practice Location Address
First Line	:	248 OLD POLLOCK RD
Second Line	:
City	:	POLLOCK
State	:	ID
Zip	:	83547-0000
Country	:	US
Telephone Number	:	208-315-0993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2020
Last Update Date	:	03/28/2025

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Directions to “ HEIDY MEAD ” Practice Location

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