| Doctor Name: | MRS. TARYN SUZANNE IVIE |
| NPI Number: | 1124412747 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CADC |
| License Number: | 10221 |
| Business Practice Address: | 1320 N 3300 E Ashton, ID - 834205018 |
| Business Phone Number: | 2085899054 |
| Business Fax Number: | 2086241351 |
| Mailing Address: | 1320 N 3300 E, ASHTON |
| State: | ID |
| Postal Code: | 834205018 |
| Phone Number: | 2085899054 |
| Fax Number: | 2086241351 |
| NPI Enumeration Date: | 03/20/2015 |
| NPI Last Update Date: | 03/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 10221 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |