Healthcare Provider Details

I. General information

NPI: 1629892179
Provider Name (Legal Business Name): DARLA HORNE VALORA LAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 4TH S
REXBURG ID
83440
US

IV. Provider business mailing address

3623 W 3200 S
REXBURG ID
83440-4746
US

V. Phone/Fax

Practice location:
  • Phone: 208-524-7400
  • Fax:
Mailing address:
  • Phone: 208-360-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5961474
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: