Provider Demographics
NPI:1962737643
Name:KENT, WILLIAM TAGGART (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TAGGART
Last Name:KENT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 RAPID LIGHTNING RD
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-7948
Mailing Address - Country:US
Mailing Address - Phone:208-290-2771
Mailing Address - Fax:
Practice Address - Street 1:608 S DIVISION AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1749
Practice Address - Country:US
Practice Address - Phone:208-265-5049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-256011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical