MR. Thayne Andersen, LCSW

NPI #1194909952 in Fort Hall, Idaho

Provider Information

NPI Number: 1194909952
Entity Type: Individual
Name: MR. Thayne Andersen, LCSW
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Social Worker - Clinical
Credential: LCSW
Enumeration Date: Dec 28, 2007
Last Updated: Dec 28, 2007

Practice Location

Address: 717 MISSION ROAD
City: Fort Hall
State: Idaho
ZIP Code: 83203-0306
Phone: (208) 237-5631

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary

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