Individual
TAMMY PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
630 ADDISON AVE W STE 1000, TWIN FALLS, ID 83301-5853
(208) 736-5048
(208) 735-2126
Mailing address
630 ADDISON AVE W STE 1000, TWIN FALLS, ID 83301-5853
(208) 736-5048
(208) 735-2126
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1144008
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558606962
—
ID
Enumeration date
01/21/2014
Last updated
09/23/2024
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