Provider Demographics
NPI:1700325461
Name:DIEPENBROCK, KATHLEEN (LPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DIEPENBROCK
Suffix:
Gender:F
Credentials:LPC
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 4683
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-4683
Mailing Address - Country:US
Mailing Address - Phone:208-720-0941
Mailing Address - Fax:208-788-5692
Practice Address - Street 1:314 S RIVER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8851
Practice Address - Country:US
Practice Address - Phone:208-788-5625
Practice Address - Fax:208-788-5692
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC -4732101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor