Provider Demographics
NPI:1871828657
Name:WILSON, HEATHER L (LCPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:WILSON
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 1:2484 W BETH LOOP
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5366
Mailing Address - Country:US
Mailing Address - Phone:208-889-1355
Mailing Address - Fax:208-625-2036
Practice Address - Street 1:1103 W IRONWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2604
Practice Address - Country:US
Practice Address - Phone:208-889-1355
Practice Address - Fax:208-625-2036
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1431101YM0800X
IDLPC-5407101YM0800X
IDLCPC-5644101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health