| NPI | 1043515133 |
|---|---|
| Former Legal Business Name | TYLENE CHANNER COUNSELING |
| Entity Type | Organization |
| Authorized Contact | TYLENE CHANNER Owner/President 208-936-1097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-29427) |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2017-10-06 |