Healthcare Provider Details

I. General information

NPI: 1629465174
Provider Name (Legal Business Name): TAMMY L FELPS PHD, SE, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 WASHINGTON ST N
TWIN FALLS ID
83301-5032
US

IV. Provider business mailing address

209 WASHINGTON ST N
TWIN FALLS ID
83301-5032
US

V. Phone/Fax

Practice location:
  • Phone: 208-654-0134
  • Fax:
Mailing address:
  • Phone: 208-654-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC-7507
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberSE-203241
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: