Healthcare Provider Details

I. General information

NPI: 1770720583
Provider Name (Legal Business Name): KIMBERLY ANN FAILES MS LPC LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ANN FAILES MS LCPC

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 FALLS AVE
TWIN FALLS ID
83301-3373
US

IV. Provider business mailing address

378 FALLS AVE
TWIN FALLS ID
83301-3373
US

V. Phone/Fax

Practice location:
  • Phone: 208-293-8062
  • Fax: 208-293-8082
Mailing address:
  • Phone: 208-293-8062
  • Fax: 208-293-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC 5870
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLCPC 5870
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC 5870
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCPC 5870
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: