Individual
TANJA DAWN CORNELISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
210 E CENTER ST STE B, POCATELLO, ID 83201-6326
(208) 234-2600
(208) 234-2800
Mailing address
5140 CONSTITUTION AVE, CHUBBUCK, ID 83202-3076
(208) 604-0155
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-3452
ID
Other
Enumeration date
10/07/2008
Last updated
10/07/2008
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