Provider Demographics
NPI:1073349270
Name:TINSLEY, ANGELA (MSW INTERN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:OCKERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1820 E 17TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6400
Mailing Address - Country:US
Mailing Address - Phone:208-497-0685
Mailing Address - Fax:
Practice Address - Street 1:1820 E 17TH ST STE 330
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6400
Practice Address - Country:US
Practice Address - Phone:208-497-0685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker