Provider Demographics
NPI:1780264242
Name:BIRDSALL, BOBBIE ANN (PHD, LCPC)
Entity type:Individual
Prefix:DR
First Name:BOBBIE
Middle Name:ANN
Last Name:BIRDSALL
Suffix:
Gender:F
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 S SCYENE WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-8532
Mailing Address - Country:US
Mailing Address - Phone:208-859-9663
Mailing Address - Fax:
Practice Address - Street 1:2211 S SCYENE WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-8532
Practice Address - Country:US
Practice Address - Phone:208-859-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPCS-264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLCPC-264OtherIDAHO