Provider Demographics
NPI:1790675049
Name:ANDERSON, ISABELLA RAQUEL (LPC)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:RAQUEL
Last Name:ANDERSON
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 1:3852 N EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-0750
Mailing Address - Country:US
Mailing Address - Phone:208-378-0014
Mailing Address - Fax:
Practice Address - Street 1:1335 S 5TH AVE APT 108
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6709
Practice Address - Country:US
Practice Address - Phone:505-363-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3571869101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor