Provider Demographics
NPI:1710692926
Name:DILL, PENELOPE (LMFT)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:DILL
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:PO BOX 2822
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-2822
Mailing Address - Country:US
Mailing Address - Phone:208-818-9314
Mailing Address - Fax:
Practice Address - Street 1:7600 N MINERAL DR STE 300
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-7763
Practice Address - Country:US
Practice Address - Phone:208-274-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-8620106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist