Provider Demographics
NPI:1003439902
Name:MEAD, HEIDY
Entity type:Individual
Prefix:
First Name:HEIDY
Middle Name:
Last Name:MEAD
Suffix:
Gender:
Credentials:
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 192
Mailing Address - Street 2:
Mailing Address - City:POLLOCK
Mailing Address - State:ID
Mailing Address - Zip Code:83547-0192
Mailing Address - Country:US
Mailing Address - Phone:208-315-0993
Mailing Address - Fax:
Practice Address - Street 1:248 OLD POLLOCK RD
Practice Address - Street 2:
Practice Address - City:POLLOCK
Practice Address - State:ID
Practice Address - Zip Code:83547-0000
Practice Address - Country:US
Practice Address - Phone:208-315-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7814101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health