Healthcare Provider Details

I. General information

NPI: 1538774716
Provider Name (Legal Business Name): TABITHA LOWER-SIMON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2273 S VISTA AVE STE 190
BOISE ID
83705-7341
US

IV. Provider business mailing address

951 E YAQUINA BAY DR
NAMPA ID
83686-8473
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-2737
  • Fax: 208-342-3238
Mailing address:
  • Phone: 208-283-6896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-7741
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: