Healthcare Provider Details

I. General information

NPI: 1760397962
Provider Name (Legal Business Name): LORI CALICO, LMFT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 RIVER OAKS ST
TWIN FALLS ID
83301-4094
US

IV. Provider business mailing address

1181 RIVER OAKS ST
TWIN FALLS ID
83301-4094
US

V. Phone/Fax

Practice location:
  • Phone: 310-422-3159
  • Fax:
Mailing address:
  • Phone: 310-422-3159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LORI CALICO
Title or Position: OWNER
Credential:
Phone: 310-422-3159