Individual
TINA MARIE FIVECOAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
THERAPY INTERN
Contact information
Practice address
1655 W FAIRVIEW AVE STE 209, BOISE, ID 83702-5190
(208) 713-9724
Mailing address
3352 N KINGSWOOD WAY, BOISE, ID 83704
(208) 713-9724
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
07/12/2023
Last updated
07/12/2023
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