Provider Demographics
NPI:1912217316
Name:BLINN, INGRID STARR (MA, LPC)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:STARR
Last Name:BLINN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 SAINT JOHNS WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2435
Mailing Address - Country:US
Mailing Address - Phone:208-750-1802
Mailing Address - Fax:208-750-1803
Practice Address - Street 1:307 SAINT JOHNS WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2435
Practice Address - Country:US
Practice Address - Phone:208-750-1802
Practice Address - Fax:208-750-1803
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60156252101YM0800X
IDLPC-4580101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health