Provider Demographics
NPI:1972746519
Name:HIBBARD, KINDRA (LCPC, LMHC)
Entity type:Individual
Prefix:
First Name:KINDRA
Middle Name:
Last Name:HIBBARD
Suffix:
Gender:F
Credentials:LCPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 KNOLL CREST DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-6707
Mailing Address - Country:US
Mailing Address - Phone:208-750-1802
Mailing Address - Fax:208-750-1803
Practice Address - Street 1:312 MILLER ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1944
Practice Address - Country:US
Practice Address - Phone:208-750-1802
Practice Address - Fax:208-750-1803
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60086695101YM0800X
IDLCPC 4160101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60086695OtherSTATE LICENSURE
IDLCPC-4160OtherSTATE LICENSURE