Provider Demographics
NPI:1114539376
Name:STEVENS, SYDNEY (LPC)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4336
Mailing Address - Country:US
Mailing Address - Phone:208-449-6491
Mailing Address - Fax:208-450-2239
Practice Address - Street 1:1022 N 4TH ST STE 101
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3100
Practice Address - Country:US
Practice Address - Phone:208-449-6491
Practice Address - Fax:208-450-2239
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC7817101Y00000X
IDLPC7817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDSSNOther0000
IDLPC-7817OtherSTATE OF IDAHO