Provider Demographics
NPI:1932490984
Name:CHATBURN, TAMERA (M ED)
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:
Last Name:CHATBURN
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:CHATBURN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M ED
Mailing Address - Street 1:284 MARTIN ST.
Mailing Address - Street 2:PREFERRED CHILD AND FAMILY SERVICES
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-733-7186
Mailing Address - Fax:208-733-7178
Practice Address - Street 1:531 EAST 5TH ST.
Practice Address - Street 2:PREFERRED CHILD AND FAMILY SERVICES
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318
Practice Address - Country:US
Practice Address - Phone:208-678-9114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-2895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional