Individual
DR. TANNER MITCHELL NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
2001 S WOODRUFF AVE STE 9, IDAHO FALLS, ID 83404-6371
(208) 419-3002
(208) 656-5652
Mailing address
2001 S WOODRUFF AVE STE 9, IDAHO FALLS, ID 83404-6371
(208) 419-3002
(208) 656-5652
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-203073
ID
Other
Enumeration date
09/22/2009
Last updated
11/29/2022
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