Provider Demographics
NPI:1932759404
Name:BEIDMAN, STEPHANIE LE ANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LE ANNE
Last Name:BEIDMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MAIN ST # 11
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1838
Mailing Address - Country:US
Mailing Address - Phone:208-746-7661
Mailing Address - Fax:208-746-0811
Practice Address - Street 1:800 MAIN ST # 11
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1838
Practice Address - Country:US
Practice Address - Phone:208-746-7661
Practice Address - Fax:208-746-0811
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW36870101Y00000X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)