Individual
TYLER DAWN MOULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
605 11TH AVE E, GOODING, ID 83330-5368
(208) 934-8461
Mailing address
605 11TH AVE E, GOODING, ID 83330-5368
(208) 934-8461
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-44450
ID
Other
Enumeration date
04/03/2024
Last updated
04/03/2024
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