Organization
PETTINGILL COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMARA K. PETTINGILL LCSW (OWNER)
(208) 542-9919
Entity
Organization
Contact information
Practice address
2267 TETON PLZ, IDAHO FALLS, ID 83404-6486
(208) 542-9919
(208) 542-6272
Mailing address
2267 TETON PLZ, IDAHO FALLS, ID 83404-6486
(208) 542-9919
(208) 542-6272
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCSW-24477
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806803500
—
ID
05
—
806864000
—
ID
05
—
807357200
—
ID
Enumeration date
07/14/2006
Last updated
08/22/2020
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