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NPI Code Detail

MEDICARE: STEPHANIE THERESE BREITENSTEIN LCPC

MEDICARE: STEPHANIE THERESE BREITENSTEIN LCPC
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
1101YP2500XProfessional CounselorLPC-16079AZ
2101YP2500XProfessional CounselorLCPC-6978ID

General Provider Information

NPI Number : 1235783564
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE THERESE BREITENSTEIN LCPC
Provider Business Mailing Address
First Line : 4477 W EMERALD ST STE C125
Second Line :
City : BOISE
State : ID
Zip : 83706-2000
Country : US
Telephone Number : 208-495-4147
Fax Number : 208-629-5131
Provider Business Practice Location Address
First Line : 4477 W EMERALD ST STE C125
Second Line :
City : BOISE
State : ID
Zip : 83706-2000
Country : US
Telephone Number : 928-853-5475
Fax Number : 208-629-5131
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2019
Last Update Date : 06/15/2026

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Directions to “ STEPHANIE THERESE BREITENSTEIN LCPC” Practice Location

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