Individual
LILLIAN BENGTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SE
Contact information
Practice address
500 S 11TH AVE STE 400, POCATELLO, ID 83201-4880
(208) 232-7862
Mailing address
500 S 11TH AVE STE 400, POCATELLO, ID 83201-4880
(208) 232-7862
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
Primary
9871578
ID
390200000X
Student in an Organized Health Care Education/Training Program
SE203528
ID
Other
Enumeration date
07/19/2021
Last updated
09/09/2025
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