Individual
TERRY FREDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
33 RIVERSIDE DR, POCATELLO, ID 83204-4025
(208) 604-3933
Mailing address
101 S MAIN ST, POCATELLO, ID 83204-3210
(208) 232-7807
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
ID
Other
Enumeration date
05/13/2025
Last updated
05/24/2025
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