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NPI Code Detail

MEDICARE: TYRA RICKMAN

MEDICARE: TYRA RICKMAN
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
1101YP2500XProfessional Counselor10588ID

General Provider Information

NPI Number : 1740022540
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYRA RICKMAN
Provider Business Mailing Address
First Line : 211 E LOGAN ST STE 201
Second Line :
City : CALDWELL
State : ID
Zip : 83605-4883
Country : US
Telephone Number : 208-454-1480
Fax Number :
Provider Business Practice Location Address
First Line : 211 E LOGAN ST STE 201
Second Line :
City : CALDWELL
State : ID
Zip : 83605-4883
Country : US
Telephone Number : 208-454-1480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2024
Last Update Date : 06/11/2024

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Directions to “ TYRA RICKMAN ” Practice Location

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