Provider Demographics
NPI:1679929350
Name:TSETSAKIS, LENORAH (LMSW)
Entity type:Individual
Prefix:
First Name:LENORAH
Middle Name:
Last Name:TSETSAKIS
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-814-4114
Mailing Address - Fax:208-814-4907
Practice Address - Street 1:2550 ADDISON AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6767
Practice Address - Country:US
Practice Address - Phone:208-814-7750
Practice Address - Fax:208-814-7759
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-33852104100000X
IDLCSW-45406104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker