Individual
TYSON DANIELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
150 N 200 W, MALAD CITY, ID 83252-1239
(208) 766-2231
(208) 766-4819
Mailing address
150 N 200 W, MALAD CITY, ID 83252-1239
(208) 766-2231
(208) 766-4819
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-36618
ID
Other
Enumeration date
05/01/2017
Last updated
05/01/2017
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