Individual
TARA ROCHELLE LYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2721
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2721
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-44073
ID
Other
Enumeration date
06/15/2018
Last updated
08/30/2023
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