Individual
REBECCA CHIDESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
771 PARKWOOD ST., IDAHO FALLS, ID 83401
(719) 641-9453
Mailing address
246 N CURLEW DR APT 5207, AMMON, ID 83401-1441
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-7222
ID
Other
Enumeration date
03/06/2019
Last updated
03/06/2019
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