Tanya Nichols
Psychologist, Clinical in Boise, ID. Individual provider (NPI-1).
NPI number1699429910
StatusActive
Last updated in NPPESFeb 6, 2022
Details
- NPI
- 1699429910
- Entity type
- Individual (NPI-1)
- Name
- Tanya Nichols
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 6, 2022
- Certification date
- Feb 4, 2022
- Last updated
- Feb 6, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TC0700X | Psychologist, Clinical | PSY-203556 | ID | Yes |
Other names
- Tanya S Watford (Other Name)
Practice location
500 W Fort StBoise, ID 83702-4501
Phone 208-422-1000
Mailing address
1018 N Webb Way Unit I104Meridian, ID 83642-8369
Phone 337-501-7341
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