Provider Demographics
NPI:1699460725
Name:FEHR, COLLIN M (EDD)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:M
Last Name:FEHR
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4335
Mailing Address - Country:US
Mailing Address - Phone:208-346-0688
Mailing Address - Fax:208-620-3027
Practice Address - Street 1:180 N WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4335
Practice Address - Country:US
Practice Address - Phone:208-346-0688
Practice Address - Fax:208-620-3027
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCOUI-9432101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor