Provider Demographics
NPI:1407154396
Name:HETTENHAUSEN, LISA K (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:HETTENHAUSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8317
Mailing Address - Country:US
Mailing Address - Phone:208-322-5859
Mailing Address - Fax:208-322-5901
Practice Address - Street 1:8400 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8317
Practice Address - Country:US
Practice Address - Phone:208-322-5859
Practice Address - Fax:208-322-5901
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-3011106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist