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: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 MAIN AVE S
TWIN FALLS ID
83301-6232
US

IV. Provider business mailing address

264 MAIN AVE S
TWIN FALLS ID
83301-6232
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-0407
  • Fax: 208-734-3534
Mailing address:
  • Phone: 208-734-0407
  • Fax: 208-734-3534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberSE-203241
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-7507
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: