Provider Demographics
NPI:1093063539
Name:WIMER, LEVI THOMAS (LPC)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:THOMAS
Last Name:WIMER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9361 SOUTH 300 EAST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070
Mailing Address - Country:US
Mailing Address - Phone:801-826-5000
Mailing Address - Fax:
Practice Address - Street 1:7711 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-6182
Practice Address - Country:US
Practice Address - Phone:208-853-8536
Practice Address - Fax:208-853-2929
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-2872101YM0800X
103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health