Kendra Tamar Pettit, LPC
Counselor, Professional in Nampa, ID. Individual provider (NPI-1).
NPI number1346674751
StatusActive
Last updated in NPPESAug 21, 2013
Details
- NPI
- 1346674751
- Entity type
- Individual (NPI-1)
- Name
- Kendra Tamar Pettit
- Credential
- LPC
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 21, 2013
- Last updated
- Aug 21, 2013
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | LPC-4861 | ID | Yes |
Practice location
1108 W Finch DrNampa, ID 83651-1732
Phone 208-991-0076
Mailing address
1820 Mace RdEagle, ID 83616-5710
Phone 208-991-0076
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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