Individual
TAMMY L EVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LCSW-27670
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-27670
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010150395
REGENCE BLUE SHIELD OF IDAHO
ID
01
—
L6025
BLUE CROSS OF IDAHO
—
Enumeration date
08/09/2007
Last updated
09/09/2023
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