Healthcare Provider Details

I. General information

NPI: 1457287252
Provider Name (Legal Business Name): PEYTON JEAN LARSEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

762 FALLS AVE
TWIN FALLS ID
83301-3316
US

IV. Provider business mailing address

762 FALLS AVE
TWIN FALLS ID
83301-3316
US

V. Phone/Fax

Practice location:
  • Phone: 208-258-7681
  • Fax:
Mailing address:
  • Phone: 208-258-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2371862
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: