Provider Demographics
NPI:1558476721
Name:MOREHOUSE, TAMMY LYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNNE
Last Name:MOREHOUSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6003 W OVERLAND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-3075
Mailing Address - Country:US
Mailing Address - Phone:208-322-2412
Mailing Address - Fax:208-345-2077
Practice Address - Street 1:413 N ALLUMBAUGH ST STE 102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9219
Practice Address - Country:US
Practice Address - Phone:208-631-7387
Practice Address - Fax:208-343-4458
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-293531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010156807OtherREGENCE BLUE SHIELD OF ID
IDX6897OtherBLUE CROSS OF IDAHO