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1487701058
TIFFANY ANN BASCOM
POCATELLO, ID
NPI
1487701058
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: ID LCPC-3801)
Enumeration Date
2007-01-04
Last Update Date
2023-12-18
Business Address
TIFFANY ANN BASCOM LCPC
2520 S 5TH AVE
POCATELLO, ID 83204-1923
Phone number: 208-233-5433
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Mailing Address
TIFFANY ANN BASCOM LCPC
2520 S 5TH AVE
POCATELLO, ID 83204-1923
Phone number: 208-233-5433
Copy
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