Individual
BRENDA PICKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
136 S ACADEMY AVE, EAGLE, ID 83616-6541
(208) 794-4097
Mailing address
2674 W DEERFIELD CT, EAGLE, ID 83616-2339
(208) 794-4097
(208) 939-9110
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-826
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
826
LSCW
ID
Enumeration date
02/08/2007
Last updated
07/08/2007
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