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NPI Code Detail

MEDICARE: TONYA HOLLIST LCSW

MEDICARE: TONYA HOLLIST LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerLMSW35094ID
21041C0700XClinical Social WorkerLCSW-38181ID

General Provider Information

NPI Number : 1598232209
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA HOLLIST LCSW
Provider Business Mailing Address
First Line : 1223 S RAILROAD AVE
Second Line :
City : SUGAR CITY
State : ID
Zip : 83448-5072
Country : US
Telephone Number : 208-359-0519
Fax Number : 208-233-2178
Provider Business Practice Location Address
First Line : 1223 S RAILROAD AVE
Second Line :
City : SUGAR CITY
State : ID
Zip : 83448-5072
Country : US
Telephone Number : 208-359-0519
Fax Number : 208-233-2178
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2018
Last Update Date : 01/04/2021

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Directions to “ TONYA HOLLIST LCSW” Practice Location

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