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Organization
PETTINGILL COUNSELING SERVICES, PROFESSIONAL CORPORATION
Active
Organization
PETTINGILL COUNSELING SERVICES, PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMARA K. PETTINGILL LCSW (OWNER)
(208) 542-9919
Entity
Organization
Contact information
Practice address
1302 E 17TH ST, IDAHO FALLS, ID 83404-6270
(208) 542-9919
(208) 542-6272
Mailing address
2267 TETON PLZ, IDAHO FALLS, ID 83404-6486
(208) 542-9919
(208) 542-6272
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCSW-24477
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806864000
—
ID
Enumeration date
04/06/2007
Last updated
12/19/2022
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