Healthcare Provider Details

I. General information

NPI: 1053612648
Provider Name (Legal Business Name): KAMI PAHLAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 162
MIDDLETON ID
83644-0162
US

IV. Provider business mailing address

PO BOX 162
MIDDLETON ID
83644-0162
US

V. Phone/Fax

Practice location:
  • Phone: 208-859-4326
  • Fax: --
Mailing address:
  • Phone: 208-859-4326
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW-30131
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLCSW-30131
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-30131
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: