Provider Demographics
NPI:1447586888
Name:TINKER, NICHOLAS R (MSW, CADC)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:R
Last Name:TINKER
Suffix:
Gender:M
Credentials:MSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8092 W POWELL ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-2185
Mailing Address - Country:US
Mailing Address - Phone:208-853-8271
Mailing Address - Fax:
Practice Address - Street 1:8092 W POWELL ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-2185
Practice Address - Country:US
Practice Address - Phone:208-853-8271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker