Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | LCPC-3657 | ID |
N | 104100000X | Social Worker | 140534-3503 | UT |
N | 104100000X | Social Worker | LSW24292 | ID |
NPI | 1003031428 |
---|---|
Provider Name | Mrs. Tamara Okelberry |
First Address | Hazelton, ID 83335-5464 |
Second Address | Twin Falls, ID 83301-6400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |