Stacie Marie Hettinga, LCPC

NPI #1386836310 in Council, Idaho

Provider Information

NPI Number: 1386836310
Entity Type: Individual
Name: Stacie Marie Hettinga, LCPC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor - Professional
Credential: LCPC
Enumeration Date: Aug 14, 2007
Last Updated: Aug 14, 2007

Practice Location

Address: 205 N BERKLEY
City: Council
State: Idaho
ZIP Code: 83612
Phone: (208) 253-6850

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Professional — Professional	101YP2500X	Primary

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