Provider Demographics
NPI:1932638509
Name:HENRICKSON, AMBER RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RENEE
Last Name:HENRICKSON
Suffix:
Gender:F
Credentials:LCSW
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 271
Mailing Address - Street 2:
Mailing Address - City:SAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83860-0271
Mailing Address - Country:US
Mailing Address - Phone:208-290-6604
Mailing Address - Fax:208-216-8055
Practice Address - Street 1:231 N THIRD AVE STE 206
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1418
Practice Address - Country:US
Practice Address - Phone:208-290-6604
Practice Address - Fax:208-216-8055
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID36787101YM0800X
ID39935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health