Tara Rochelle Lyon, LCSW
Social Worker, Clinical in Boise, ID. Individual provider (NPI-1).
NPI number1871087635
StatusActive
Last updated in NPPESAug 30, 2023
Details
- NPI
- 1871087635
- Entity type
- Individual (NPI-1)
- Name
- Tara Rochelle Lyon
- Credential
- LCSW
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 15, 2018
- Certification date
- Aug 29, 2023
- Last updated
- Aug 30, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | LCSW-44073 | ID | Yes |
Practice location
190 E Bannock StBoise, ID 83712-6241
Phone 208-381-2721
Mailing address
190 E Bannock StBoise, ID 83712-6241
Phone 208-381-2721
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