Individual
DEA HIBDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
PO BOX B, LEWISTON, ID 83501-0182
(208) 799-4440
(208) 799-5171
Mailing address
PO BOX B, LEWISTON, ID 83501-0182
(208) 799-4440
(208) 799-5171
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-5197
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCPC-5197
STATE OF IDAHO
ID
Enumeration date
03/17/2016
Last updated
03/17/2016
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