Healthcare Provider Details

I. General information

NPI: 1417883844
Provider Name (Legal Business Name): STEVEN CRAIG TANNER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 S 9TH AVE
CALDWELL ID
83605-4153
US

IV. Provider business mailing address

3800 EAST MAN O'WAR DRIVE
NAMPA ID
83686
US

V. Phone/Fax

Practice location:
  • Phone: 208-912-6994
  • Fax:
Mailing address:
  • Phone: 208-912-6994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1671193
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: