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General NPI Number Information
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NPI Number | 1316080179
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Entity Type | Individual
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Provider Name | TAMBRA EVE FOX STEWART LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 1111 S ORCHARD ST SUITE 172
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City | BOISE
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State | ID
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Zip | 83705-1966
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Country | US
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Telephone | 208-336-9591
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Fax |
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Provider Business Mailing Address
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Address Line | 1465 N TRAIL CREEK WAY
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City | EAGLE
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State | ID
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Zip | 83616-4090
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Country | US
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Telephone | 208-938-5364
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW - 29319
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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 | LCSW - 29319
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License Number State | ID
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