Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | LCPC-4258 | ID |
N | 101YM0800X | Mental Health Counselor | LCPC-4258 | ID |
N | 101YP1600X | Pastoral Counselor | LCPC-4258 | ID |
Y | 101YP2500X | Professional Counselor | LCPC-4258 | ID |
NPI | 1285767913 |
---|---|
Provider Name | Mrs. Heather Sue Tustison |
First Address | Meridian, ID 83642-8009 |
Second Address | Meridian, ID 83642-8009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 07/05/2020 |