Provider Demographics
NPI:1780046367
Name:JOHNS, TIM (LCSW)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:JOHNS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 N WESTGATE DR STE A-1
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7164
Mailing Address - Country:US
Mailing Address - Phone:208-334-0880
Mailing Address - Fax:208-334-0893
Practice Address - Street 1:1720 N WESTGATE DR STE A-1
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7164
Practice Address - Country:US
Practice Address - Phone:208-334-0880
Practice Address - Fax:208-334-0893
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-356281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical