Provider Demographics
NPI:1326360942
Name:BOETTCHER, BETHENA (BETH) LOREE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:BETHENA (BETH)
Middle Name:LOREE
Last Name:BOETTCHER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:BETHENA
Other - Middle Name:LOREE
Other - Last Name:BOETTCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1904 JENNIE LEE DR.
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404
Mailing Address - Country:US
Mailing Address - Phone:208-523-1558
Mailing Address - Fax:208-529-4788
Practice Address - Street 1:1904 JENNIE LEE DR.
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-523-1558
Practice Address - Fax:208-529-4788
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC3675101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional