Provider Demographics
NPI:1164059069
Name:ALBRIGHT, TATEN LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:TATEN
Middle Name:LEE
Last Name:ALBRIGHT
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 HOOPES AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4705
Mailing Address - Country:US
Mailing Address - Phone:208-313-1842
Mailing Address - Fax:
Practice Address - Street 1:615 HOOPES AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-6106
Practice Address - Country:US
Practice Address - Phone:208-542-0352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-39331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1518097690Medicaid