Provider Demographics
NPI:1689069460
Name:BEZDEKA, STEVE M (LCPC)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:M
Last Name:BEZDEKA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3392
Mailing Address - Country:US
Mailing Address - Phone:208-737-9999
Mailing Address - Fax:208-736-4400
Practice Address - Street 1:1373 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3392
Practice Address - Country:US
Practice Address - Phone:208-737-9999
Practice Address - Fax:208-736-4400
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional