Individual
BETSY PACK PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
2267 TETON PLZ, IDAHO FALLS, ID 83404-6486
(208) 522-0140
(208) 524-7335
Mailing address
2267 TETON PLZ, IDAHO FALLS, ID 83404-6486
(208) 522-0140
(208) 524-7335
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LMSW-38030
ID
104100000X
Social Worker
10930 (LMSW)
TN
104100000X
Social Worker
LMSW-38030
ID
Other
Enumeration date
10/19/2016
Last updated
09/21/2018
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