Provider Demographics
NPI:1902490055
Name:EATON, TABITHA KAY (LMSW)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:KAY
Last Name:EATON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 LOCUST ST N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7353
Mailing Address - Country:US
Mailing Address - Phone:208-944-9776
Mailing Address - Fax:208-481-8489
Practice Address - Street 1:459 LOCUST ST N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7353
Practice Address - Country:US
Practice Address - Phone:208-944-9776
Practice Address - Fax:208-481-8489
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-39057104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker