Individual
ELIZABETH WHITEHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
1323 AMMON PARK DR, AMMON, ID 83406-4591
(208) 932-8350
(208) 938-2330
Mailing address
1323 AMMON PARK DR, AMMON, ID 83406-4591
(208) 932-8350
(208) 938-2330
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-5751
ID
101YM0800X
Mental Health Counselor
LPC-5070
ID
Other
Enumeration date
09/12/2012
Last updated
06/30/2023
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