Tina Renee Cleverley, LMSW
Individual provider Active NPI Social Worker · Idaho Falls, ID
NPI 1760174957 · NPPES record last updated May 24, 2023
Key facts
- NPI
- 1760174957
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- LMSW-43623 (ID)
- Practice address
- 1810 W Broadway St
Idaho Falls, ID 83402-5072 - Phone
- (208) 552-7011
- NPI assigned
- May 24, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMSW-43623 | ID | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pettingill Counseling Services, Professional Corporation | Past | Accepting new patients | |
| America Health Inc | Social Worker | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | ID | ||
| Social Worker | 104100000X | LMSW-43623 | ID | Yes |
Addresses
Primary practice location
1810 W Broadway St
Idaho Falls, ID 83402-5072
Mailing address
665 John Adams Pkwy
Idaho Falls, ID 83401-4072
Phone (208) 552-7011
Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.