Provider Demographics
NPI:1508038522
Name:HEDRICK, AMY ELISA (LCPC, CST)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELISA
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:LCPC, CST
Other - Prefix:
Other - First Name:EMBODIED WELLNESS
Other - Middle Name:
Other - Last Name:INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC, CST
Mailing Address - Street 1:3945 N PARK CROSSING AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6312
Mailing Address - Country:US
Mailing Address - Phone:208-724-0426
Mailing Address - Fax:208-505-5067
Practice Address - Street 1:13945 W WAINWRIGHT DR STE 103
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1912
Practice Address - Country:US
Practice Address - Phone:208-724-0426
Practice Address - Fax:208-505-5067
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4242101YP2500X
IDACADC 89101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)