Provider Demographics
NPI:1841366929
Name:BILLS, SANDRA (MAED, LCPC)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:BILLS
Suffix:
Gender:F
Credentials:MAED, LCPC
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 3067
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83206-3067
Mailing Address - Country:US
Mailing Address - Phone:208-787-9804
Mailing Address - Fax:208-233-9454
Practice Address - Street 1:150 S ARTHUR AVE STE 221
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3248
Practice Address - Country:US
Practice Address - Phone:208-787-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
18413669229OtherCAQH AND INSURANCE