1225270523 NPI number — MRS. NORMA JEAN HERSHEY LMFT LCPC

Table of content: MRS. NORMA JEAN HERSHEY LMFT LCPC (NPI 1225270523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225270523 NPI number — MRS. NORMA JEAN HERSHEY LMFT LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERSHEY
Provider First Name:
NORMA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERSHEY
Provider Other First Name:
JEANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT LCPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225270523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOX 694
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAYETTE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83661-0694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-739-6818
Provider Business Mailing Address Fax Number:
208-642-2796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
695 2ND AVE S,
Provider Second Line Business Practice Location Address:
NORTH ENTRANCE
Provider Business Practice Location Address City Name:
PAYETTE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83661-0694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-739-6818
Provider Business Practice Location Address Fax Number:
208-642-2796
Provider Enumeration Date:
04/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  LCPC 830 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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