Provider Demographics
NPI:1801191515
Name:MANDERSCHEID, CAROL (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:MANDERSCHEID
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:M
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:284 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4542
Mailing Address - Country:US
Mailing Address - Phone:208-733-7186
Mailing Address - Fax:208-733-7178
Practice Address - Street 1:284 MARTIN ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4542
Practice Address - Country:US
Practice Address - Phone:208-733-7186
Practice Address - Fax:208-733-7178
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLPC-4411OtherIDAHO BUREAU OF OCCUPATIONAL LICENSES