Organization Name: | TYLENE CHANNER COUNSELING |
NPI Number: | 1043515133 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TYLENE CHANNER (CO-OWNER, OPERATOR) |
Mailing Address: | 1305 3rd St S Nampa |
State: | ID US |
Postal Code: | 836513903 |
Phone Number: | 2084755701 |
Fax Number: | 2084755710 |
NPI Enumeration Date: | 01/20/2011 |
NPI Last Update Date: | 01/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LCSW-29427 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |