Healthcare Provider Details

I. General information

NPI: 1225384779
Provider Name (Legal Business Name): TIFFANY MARIE NIELSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3852 N EAGLE RD
BOISE ID
83713-0750
US

IV. Provider business mailing address

3852 N EAGLE RD
BOISE ID
83713-0750
US

V. Phone/Fax

Practice location:
  • Phone: 208-378-0014
  • Fax:
Mailing address:
  • Phone: 208-378-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9071569
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178015214
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: