Provider Demographics
NPI:1013131366
Name:BENTLEY, NANCY (LCPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:HENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, NCC
Mailing Address - Street 1:265 E CHUBBUCK ROAD
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5055
Mailing Address - Country:US
Mailing Address - Phone:208-237-1711
Mailing Address - Fax:208-237-9806
Practice Address - Street 1:265 E CHUBBUCK ROAD
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-5055
Practice Address - Country:US
Practice Address - Phone:208-237-1711
Practice Address - Fax:208-237-9806
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC- 4707101YP2500X
IDLCPC 4707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807197600Medicaid