THAYNE ANDERSEN

FORT HALL, ID
NPI1194909952
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: ID  LCSW-27518)
Enumeration Date2007-12-28
Last Update Date2007-12-28
Business Address
Mr. THAYNE ANDERSEN LCSW
717 MISSION ROAD
FORT HALL, ID 83203-0306
Phone number: 208-237-5631
Mailing Address
Mr. THAYNE ANDERSEN LCSW
PO BOX 306
FORT HALL, ID 83203-0306
Phone number: 208-237-5631
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