| City Creek Counseling, Llc | |
|
1219 Yellowstone Ave Ste D Pocatello ID 83201-4368 | |
| (208) 339-0909 | |
| (208) 339-0909 |
| Full Name | City Creek Counseling, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1219 Yellowstone Ave Ste D, Pocatello, Idaho |
| Authorized Official Name and Position | Tandice Chaelee Peterson (CO-OWNER) |
| Authorized Official Contact | 2083390909 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| City Creek Counseling, Llc 1219 Yellowstone Ave Ste D Pocatello ID 83201-4368 Ph: (208) 339-0909 | City Creek Counseling, Llc 1219 Yellowstone Ave Ste D Pocatello ID 83201-4368 Ph: (208) 339-0909 |
| NPI Number | 1649756057 |
|---|---|
| Provider Enumeration Date | 07/18/2018 |
| Last Update Date | 07/18/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649756057 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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