Provider Demographics
NPI:1346929825
Name:FIVECOAT, TINA MARIE (THERAPY INTERN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:FIVECOAT
Suffix:
Gender:F
Credentials:THERAPY INTERN
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3352 N KINGSWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-713-9724
Mailing Address - Fax:
Practice Address - Street 1:1655 W FAIRVIEW AVE STE 209
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5190
Practice Address - Country:US
Practice Address - Phone:208-713-9724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist