Individual
TAMRA J PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW, CADC
Contact information
Practice address
1246 YELLOWSTONE AVE BLDG F, POCATELLO, ID 83201-4374
(208) 237-9194
(208) 237-2646
Mailing address
1246 YELLOWSTONE AVE BLDG F, POCATELLO, ID 83201-4374
(208) 237-9194
(208) 237-2646
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11820
ID
1041C0700X
Clinical Social Worker
Primary
LMSW-39018
ID
Other
Enumeration date
03/19/2020
Last updated
03/27/2020
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