Provider Demographics
NPI:1063922383
Name:TOWNSEND, TINA (LMSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 RATTLESNAKE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-4220
Mailing Address - Country:US
Mailing Address - Phone:208-587-2226
Mailing Address - Fax:208-587-4195
Practice Address - Street 1:110 RATTLESNAKE AVE STE B
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-4220
Practice Address - Country:US
Practice Address - Phone:208-587-2226
Practice Address - Fax:208-587-4195
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-35896104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker