Provider Demographics
NPI:1003439902
Name:MEAD, HEIDY
Entity Type:Individual
Prefix:
First Name:HEIDY
Middle Name:
Last Name:MEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 NAVAJO DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-7912
Mailing Address - Country:US
Mailing Address - Phone:208-315-0993
Mailing Address - Fax:
Practice Address - Street 1:125 COMMERCE ST STE B
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-5192
Practice Address - Country:US
Practice Address - Phone:208-634-2962
Practice Address - Fax:208-634-5064
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health