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Organization
CITY CREEK COUNSELING, LLC
Active
Organization
CITY CREEK COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANDICE CHAELEE PETERSON LCPC (CO-OWNER)
(208) 339-0909
Entity
Organization
Contact information
Practice address
1219 YELLOWSTONE AVE STE D, POCATELLO, ID 83201-4368
(208) 339-0909
(208) 339-0909
Mailing address
1219 YELLOWSTONE AVE STE D, POCATELLO, ID 83201-4368
(208) 339-0909
(208) 339-0909
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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