Provider Demographics
NPI:1477439636
Name:KOEPNICK, HEIDI LEE (LPC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LEE
Last Name:KOEPNICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 W 200 S
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-6602
Mailing Address - Country:US
Mailing Address - Phone:208-219-4560
Mailing Address - Fax:
Practice Address - Street 1:101 W 18TH ST
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2422
Practice Address - Country:US
Practice Address - Phone:208-572-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6071260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health