Healthcare Provider Details

I. General information

NPI: 1245603901
Provider Name (Legal Business Name): PAMELA BROWN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 4TH S
REXBURG ID
83440-2319
US

IV. Provider business mailing address

420 W 4TH S
REXBURG ID
83440-2319
US

V. Phone/Fax

Practice location:
  • Phone: 208-656-4017
  • Fax: 208-524-8004
Mailing address:
  • Phone: 208-656-4017
  • Fax: 208-524-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-7941
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: