Provider Demographics
NPI:1609410489
Name:GUTENBERGER, ANGELIKA H (LPC)
Entity type:Individual
Prefix:
First Name:ANGELIKA
Middle Name:H
Last Name:GUTENBERGER
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 1:109 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83448-1501
Mailing Address - Country:US
Mailing Address - Phone:208-201-8373
Mailing Address - Fax:
Practice Address - Street 1:211 S WOODRUFF AVE STE A3
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4865
Practice Address - Country:US
Practice Address - Phone:208-524-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7456101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health