Individual
MRS. TYLENE K CHANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5700 E FRANKLIN RD, SUITE 220E, NAMPA, ID 83687-8497
(208) 936-1097
Mailing address
2965 E TARPON DR, SUITE 150, MERIDIAN, ID 83642-9009
(208) 287-9420
(208) 287-9426
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-29427
ID
Other
Enumeration date
09/17/2009
Last updated
05/10/2013
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