Provider Demographics
NPI:1932422318
Name:VANEGAS, TAMRA SUSANNE (MA, LPC, MAC)
Entity Type:Individual
Prefix:MRS
First Name:TAMRA
Middle Name:SUSANNE
Last Name:VANEGAS
Suffix:
Gender:F
Credentials:MA, LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14144 W BATTENBERG CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1241
Mailing Address - Country:US
Mailing Address - Phone:208-938-0988
Mailing Address - Fax:208-323-0775
Practice Address - Street 1:3023 E COPPER POINT DR STE 205
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9290
Practice Address - Country:US
Practice Address - Phone:208-343-7797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3149101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional