Individual
TINA RENEE CLEVERLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1810 W BROADWAY ST, IDAHO FALLS, ID 83402-5072
(208) 552-7011
Mailing address
665 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4072
(208) 552-7011
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-43623
ID
104100000X
Social Worker
—
ID
Other
Enumeration date
05/24/2023
Last updated
05/24/2023
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