Individual
TARA LYNN HENDRICKSON SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
905 E BANNOCK ST, BOISE, ID 83712-7913
(208) 445-1528
(208) 593-4413
Mailing address
905 E BANNOCK ST, BOISE, ID 83712-7913
(208) 412-1207
(208) 321-0221
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
39796
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-43773
ID
Other
Enumeration date
07/09/2020
Last updated
06/18/2024
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