Individual
MARY L TASHIRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2235 E 25TH ST, IDAHO FALLS, ID 83404-7519
(208) 522-9812
(208) 522-9859
Mailing address
PO BOX 3051, IDAHO FALLS, ID 83403-3051
(208) 522-9812
(208) 522-9859
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-32597
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805405600
—
ID
Enumeration date
05/30/2012
Last updated
09/30/2013
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