Provider Demographics
NPI:1790032324
Name:CARPENTER, HEIDI (LCPC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 E COPPER POINT DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9290
Mailing Address - Country:US
Mailing Address - Phone:208-914-8924
Mailing Address - Fax:
Practice Address - Street 1:3050 N LAKEHARBOR LN STE 120
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-6917
Practice Address - Country:US
Practice Address - Phone:208-830-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6363101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health