Provider Demographics
NPI:1740020569
Name:FUENZALIDA, LUZ-EUGENIA (LPC, BC-TMH)
Entity type:Individual
Prefix:
First Name:LUZ-EUGENIA
Middle Name:
Last Name:FUENZALIDA
Suffix:
Gender:F
Credentials:LPC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 E WHITNEY CT
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-3886
Mailing Address - Country:US
Mailing Address - Phone:405-659-0852
Mailing Address - Fax:
Practice Address - Street 1:3071 E FRANKLIN RD # 201
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2376
Practice Address - Country:US
Practice Address - Phone:208-807-2877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9815101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional