Provider Demographics
NPI:1235250721
Name:SEPA-NEWELL, LINDA DENISE (MA,ABS)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:DENISE
Last Name:SEPA-NEWELL
Suffix:
Gender:F
Credentials:MA,ABS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W IRONWOOD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2660
Mailing Address - Country:US
Mailing Address - Phone:208-783-0660
Mailing Address - Fax:208-665-5735
Practice Address - Street 1:14 EMERSON LN
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2454
Practice Address - Country:US
Practice Address - Phone:208-783-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-3027106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist