| Tegmentum Counseling Services Llc | |
|
1033 W Pennwood St Meridian ID 83642-2878 | |
| (208) 409-1354 | |
| Not Available |
| Full Name | Tegmentum Counseling Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1033 W Pennwood St, Meridian, Idaho |
| Authorized Official Name and Position | Kersondra Corrine Hood (OWNER) |
| Authorized Official Contact | 2084091354 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tegmentum Counseling Services Llc 1033 W Pennwood St Meridian ID 83642-2878 Ph: (208) 409-1354 | Tegmentum Counseling Services Llc 1033 W Pennwood St Meridian ID 83642-2878 Ph: (208) 409-1354 |
| NPI Number | 1689376238 |
|---|---|
| Provider Enumeration Date | 03/20/2023 |
| Last Update Date | 03/20/2023 |
| Certification Date | 03/19/2023 |
| Medicare PECOS PAC ID | 8022473735 |
|---|---|
| Medicare Enrollment ID | O20230503000352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689376238 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kersondra Corrine Hood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598278673 PECOS PAC ID: 0244661825 Enrollment ID: I20200514002555 |
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