Healthcare Provider Details

I. General information

NPI: 1487061818
Provider Name (Legal Business Name): NICK ALLISON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 11/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 E 4TH N STE 231
REXBURG ID
83440-6009
US

IV. Provider business mailing address

405 W 4TH S
REXBURG ID
83440-2319
US

V. Phone/Fax

Practice location:
  • Phone: 208-656-4017
  • Fax: 208-656-4018
Mailing address:
  • Phone: 208-534-8607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-5525
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: