Provider Demographics
NPI:1386461739
Name:ALDRICH, KODY K (LPC)
Entity type:Individual
Prefix:
First Name:KODY
Middle Name:K
Last Name:ALDRICH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 E MOODY RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83448-5055
Mailing Address - Country:US
Mailing Address - Phone:208-573-7300
Mailing Address - Fax:
Practice Address - Street 1:242 E 7TH N STE 4
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3550
Practice Address - Country:US
Practice Address - Phone:208-359-9683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3561677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health