Individual
MR. THAYNE ANDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
717 MISSION ROAD, FORT HALL, ID 83203-0306
(208) 237-5631
(208) 237-5796
Mailing address
PO BOX 306, FORT HALL, ID 83203-0306
(208) 237-5631
(208) 237-5796
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-27518
ID
Other
Enumeration date
12/28/2007
Last updated
12/28/2007
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