Healthcare Provider Details

I. General information

NPI: 1205744232
Provider Name (Legal Business Name): MEGAN NICOLE SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 FALLS AVE E STE 703
TWIN FALLS ID
83301-3455
US

IV. Provider business mailing address

1411 FALLS AVE E STE 703
TWIN FALLS ID
83301-3455
US

V. Phone/Fax

Practice location:
  • Phone: 208-737-0572
  • Fax: 208-734-9441
Mailing address:
  • Phone: 208-737-0572
  • Fax: 208-734-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1081131
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: