Individual
MRS. TIFFANY JEAN KRUMM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
1032 S BRIDGE WAY PL, EAGLE, ID 83616-6099
(208) 475-0800
(208) 246-0125
Mailing address
1032 S BRIDGE WAY PL, EAGLE, ID 83616-6099
(208) 475-0800
(208) 246-0125
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC-4758
ID
101YM0800X
Mental Health Counselor
LPC-4758
ID
101YP2500X
Professional Counselor
Primary
LPC-4758
ID
101YS0200X
School Counselor
LPC-4758
ID
Other
Enumeration date
05/21/2012
Last updated
05/21/2012
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