Healthcare Provider Details

I. General information

NPI: 1619481736
Provider Name (Legal Business Name): TENNILLE KARA KOBER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 EASTLAND DR
TWIN FALLS ID
83301-6858
US

IV. Provider business mailing address

794 EASTLAND DR
TWIN FALLS ID
83301-6856
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-1281
  • Fax: 208-734-1282
Mailing address:
  • Phone: 208-490-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW34541
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: