MEDICARE: HEIDI CARPENTER 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
1	101YM0800X	Mental Health Counselor	LCPC-6363	ID

General Provider Information

NPI Number	:	1790032324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI CARPENTER LCPC

Provider Business Mailing Address
First Line	:	3023 E COPPER POINT DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-9290
Country	:	US
Telephone Number	:	208-914-8924
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 N LAKEHARBOR LN STE 120
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-6917
Country	:	US
Telephone Number	:	208-830-2820
Fax Number	:

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

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	02/13/2024

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Directions to “ HEIDI CARPENTER LCPC” Practice Location

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