Provider Demographics
NPI:1497318802
Name:PESTELL, BILLYLYNN LEIUILANI HAN (LCSW)
Entity type:Individual
Prefix:
First Name:BILLYLYNN
Middle Name:LEIUILANI HAN
Last Name:PESTELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BILLYLYNN
Other - Middle Name:
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6692 W MORRIS HILL LN APT 103
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9282
Mailing Address - Country:US
Mailing Address - Phone:208-398-0826
Mailing Address - Fax:
Practice Address - Street 1:410 S ORCHARD ST STE 124
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1210
Practice Address - Country:US
Practice Address - Phone:208-398-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-339671041C0700X
IDLCSW-435021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical