| Pettingill Counseling Services | |
|
2267 Teton Plz Idaho Falls ID 83404-6486 | |
| (208) 542-9919 | |
| (208) 542-6272 |
| Full Name | Pettingill Counseling Services |
|---|---|
| Speciality | Counselor |
| Location | 2267 Teton Plz, Idaho Falls, Idaho |
| Authorized Official Name and Position | Tamara K. Pettingill (OWNER) |
| Authorized Official Contact | 2085429919 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pettingill Counseling Services 2267 Teton Plz Idaho Falls ID 83404-6486 Ph: (208) 542-9919 | Pettingill Counseling Services 2267 Teton Plz Idaho Falls ID 83404-6486 Ph: (208) 542-9919 |
| NPI Number | 1811913676 |
|---|---|
| Provider Enumeration Date | 07/14/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811913676 | NPI | - | NPPES |
| 807357200 | Medicaid | ID | |
| 806803500 | Medicaid | ID | |
| 806864000 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | LCSW-24477 (Idaho) | Primary |
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