Individual
TANYA NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
1018 N WEBB WAY UNIT I104, MERIDIAN, ID 83642-8369
(337) 501-7341
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-203556
ID
Other
Enumeration date
02/06/2022
Last updated
02/06/2022
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