Provider Demographics
NPI:1043652571
Name:WEBSTER, CREED SIMON (LCPC)
Entity Type:Individual
Prefix:
First Name:CREED
Middle Name:SIMON
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S 2ND W
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440
Mailing Address - Country:US
Mailing Address - Phone:208-709-7248
Mailing Address - Fax:208-496-5127
Practice Address - Street 1:30 S 2ND W
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440
Practice Address - Country:US
Practice Address - Phone:208-709-7248
Practice Address - Fax:208-496-5127
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC #3276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health