Individual
ERIC SCOTT FERNELIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
339 E 7TH N, REXBURG, ID 83440-5124
(801) 510-4750
Mailing address
339 E 7TH N, REXBURG, ID 83440-5124
(801) 510-4750
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
41939
TX
1041C0700X
Clinical Social Worker
Primary
LCSW-37720
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86550Q
BLUE CROSS BLUE SHIELD
TX
Enumeration date
04/12/2007
Last updated
05/05/2022
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