Healthcare Provider Details

I. General information

NPI: 1982539664
Provider Name (Legal Business Name): SERENIDAD PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 RIVER VISTA PL STE 201
TWIN FALLS ID
83301-3060
US

IV. Provider business mailing address

139 RIVER VISTA PL STE 201
TWIN FALLS ID
83301-3060
US

V. Phone/Fax

Practice location:
  • Phone: 208-858-5175
  • Fax: 208-858-5175
Mailing address:
  • Phone: 208-858-5175
  • Fax: 208-858-5175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NOHEMI VASQUEZ
Title or Position: LPC
Credential: PHD
Phone: 208-858-5175