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Individual

TIFFANY ANN BASCOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCPC

Contact information

Practice address
2520 S 5TH AVE, POCATELLO, ID 83204-1923
(208) 233-5433
Mailing address
2520 S 5TH AVE, POCATELLO, ID 83204-1923
(208) 233-5433
(208) 284-2783

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-3801
ID

Other

Enumeration date
01/04/2007
Last updated
12/18/2023
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