Provider Demographics
NPI:1194269688
Name:BAIRD HEPWORTH, ANGELA (LPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BAIRD HEPWORTH
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 1:372 S EAGLE RD
Mailing Address - Street 2:# 117
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5908
Mailing Address - Country:US
Mailing Address - Phone:208-870-2069
Mailing Address - Fax:
Practice Address - Street 1:25612 KINGSBURY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-5349
Practice Address - Country:US
Practice Address - Phone:208-870-2069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health