| Pettingill Counseling Services, Professional Corporation | |
|
1302 E 17th St Idaho Falls ID 83404-6270 | |
| (208) 542-9919 | |
| (208) 542-6272 |
| Full Name | Pettingill Counseling Services, Professional Corporation |
|---|---|
| Speciality | Counselor |
| Location | 1302 E 17th St, 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, Professional Corporation 2267 Teton Plz Idaho Falls ID 83404-6486 Ph: (208) 542-9919 | Pettingill Counseling Services, Professional Corporation 1302 E 17th St Idaho Falls ID 83404-6270 Ph: (208) 542-9919 |
| NPI Number | 1194847285 |
|---|---|
| Provider Enumeration Date | 04/06/2007 |
| Last Update Date | 12/19/2022 |
| Certification Date | 12/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194847285 | NPI | - | NPPES |
| 806864000 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | LCSW-24477 (Idaho) | Primary |
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