| Obsidian Counseling Llc | |
|
200 S Main St Ste P1 Pocatello ID 83204-3261 | |
| (208) 244-6799 | |
| (208) 274-9407 |
| Full Name | Obsidian Counseling Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 200 S Main St Ste P1, Pocatello, Idaho |
| Authorized Official Name and Position | Yesenia Ibarra Trejo (OWNER) |
| Authorized Official Contact | 2082446799 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Obsidian Counseling Llc 200 S Main St Ste P1 Pocatello ID 83204-3261 Ph: (208) 244-6799 | Obsidian Counseling Llc 200 S Main St Ste P1 Pocatello ID 83204-3261 Ph: (208) 244-6799 |
| NPI Number | 1205720364 |
|---|---|
| Provider Enumeration Date | 06/04/2025 |
| Last Update Date | 06/04/2025 |
| Certification Date | 06/04/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205720364 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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