Healthcare Provider Details

I. General information

NPI: 1982525093
Provider Name (Legal Business Name): KRISTEN TRACY FISHER-LOOYENGA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN TRACY LOOYENGA

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 W USTICK RD STE 110
MERIDIAN ID
83646-7740
US

IV. Provider business mailing address

2674 W JAYTON DR
MERIDIAN ID
83642-7640
US

V. Phone/Fax

Practice location:
  • Phone: 208-837-1553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: