Individual
TIFFANY MARIE NIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
224 EVANS LN, SUITE 1, CHUBBUCK, ID 83202-1912
(208) 237-4782
Mailing address
224 EVANS LN, SUITE 1, CHUBBUCK, ID 83202-1912
(208) 237-4782
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-5044
ID
Other
Enumeration date
08/01/2012
Last updated
07/02/2014
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