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General NPI Number Information
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NPI Number | 1194942185
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Entity Type | Individual
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Provider Name | KATHLEEN S TOMAZIN LCPC
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 90 W JUDICIAL ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-2715
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Country | US
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Telephone | 208-782-2060
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Fax | 208-782-0209
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Provider Business Mailing Address
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Address Line | 90 W JUDICIAL ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-2715
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Country | US
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Telephone | 208-782-2060
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Fax | 208-782-0209
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC 332
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW 1810
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License Number State | ID
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