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General NPI Number Information
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NPI Number | 1568078681
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Entity Type | Individual
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Provider Name | TAMMY LYN LAW-MCMILLAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 524 S 9TH AVE
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City | CALDWELL
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State | ID
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Zip | 83605-5075
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Country | US
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Telephone | 82-454-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 608 SPRUCE CREEK DR
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City | NAMPA
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State | ID
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Zip | 83686-9716
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Country | US
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Telephone | 208-559-5356
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-39858
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-43180
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License Number State | ID
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