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Organization
PATHWAY COUNSELING
Active
Organization
PATHWAY COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANDICE PETERSON LCPC (PROVIDER/OWNER)
(208) 427-5891
Entity
Organization
Contact information
Practice address
1777 E CLARK ST STE 210, POCATELLO, ID 83201-3357
(208) 427-5891
(208) 427-5895
Mailing address
1777 E CLARK ST STE 210, POCATELLO, ID 83201-3357
(208) 427-5891
(208) 427-5895
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
11/17/2023
Last updated
11/17/2023
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