Provider Demographics
NPI:1679821987
Name:HOLBROOK, SALLY ANN (LCPC-S)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ANN
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:LCPC-S
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:ANN
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC-S
Mailing Address - Street 1:148 S COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0932
Mailing Address - Country:US
Mailing Address - Phone:086-683-8320
Mailing Address - Fax:208-969-8380
Practice Address - Street 1:496 SHOUP AVE W STE F
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5043
Practice Address - Country:US
Practice Address - Phone:208-683-8320
Practice Address - Fax:208-969-8380
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health