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Individual

MRS. TANDICE PETERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

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
101YM0800X
Mental Health Counselor
Primary
101YP2500X
Professional Counselor
LCPC-7004
ID

Other

Enumeration date
02/22/2012
Last updated
07/11/2023
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