Healthcare Provider Details

I. General information

NPI: 1457176976
Provider Name (Legal Business Name): TRISTAN ALYSSA MCAFEE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E 2ND N
REXBURG ID
83440-1605
US

IV. Provider business mailing address

3339 S CABIN CREEK WAY
MERIDIAN ID
83642-5783
US

V. Phone/Fax

Practice location:
  • Phone: 208-359-4840
  • Fax:
Mailing address:
  • Phone: 801-602-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4771930
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: