Healthcare Provider Details

I. General information

NPI: 1306220272
Provider Name (Legal Business Name): TAMARA THORNE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 01/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 S FIVE MILE RD
BOISE ID
83709-2325
US

IV. Provider business mailing address

2577 S FIVE MILE RD
BOISE ID
83709-2325
US

V. Phone/Fax

Practice location:
  • Phone: 208-908-6320
  • Fax:
Mailing address:
  • Phone: 208-908-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5892
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: