NPI 1780105767 · live from the CMS NPI Registry
Evan Tullis Anderson, LCSW
Social Worker, Clinical in Boise, ID. National Provider Identifier 1780105767, active.
NPI record
| NPI | 1780105767 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Social Worker, Clinical 1041C0700X |
| Practice location | 300 S 23rd St, Boise, ID 83702 |
| Practice phone | 208-344-3512 |
| Mailing address | Po Box 9, Nampa, ID 83653 |
| Enumerated | June 29, 2017 |
| Last updated | June 11, 2026 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Social Worker, Clinical primary | 1041C0700X | LCSW-42535 (ID) |
| Social Worker, Clinical | 1041C0700X | 34856 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.