Individual
MRS. KAITLYN DREW BISHARAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
495 EMERALD AVE, BLACKFOOT, ID 83221-3968
(208) 932-4545
(208) 881-9038
Mailing address
62 S 1200 W, BLACKFOOT, ID 83221-6075
(208) 681-7309
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6861160
ID
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6861160
ID
101YP2500X
Professional Counselor
6861160
ID
Other
Enumeration date
03/31/2025
Last updated
03/31/2025
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