| Pettingill Counseling Services, Professional Corporation | |
|
1302 E 17th St Idaho Falls ID 83404-6270 | |
| (208) 542-9919 | |
| (208) 542-6272 |
| Full Name | Pettingill Counseling Services, Professional Corporation |
|---|---|
| Speciality | Counselor |
| Location | 1302 E 17th St, Idaho Falls, Idaho |
| Authorized Official Name and Position | Tamara K. Pettingill (OWNER) |
| Authorized Official Contact | 2085429919 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pettingill Counseling Services, Professional Corporation 1302 E 17th St Idaho Falls ID 83404-6270 Ph: (208) 542-9919 | Pettingill Counseling Services, Professional Corporation 1302 E 17th St Idaho Falls ID 83404-6270 Ph: (208) 542-9919 |
| NPI Number | 1891919890 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 01/04/2023 |
| Certification Date | 06/30/2022 |
| Medicare PECOS PAC ID | 9133598501 |
|---|---|
| Medicare Enrollment ID | O20221206002540 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891919890 | NPI | - | NPPES |
| 806803500 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Tamara K Pettingill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629081864 PECOS PAC ID: 8527093996 Enrollment ID: I20051012000496 |
| Provider Name | Kenna L Chancey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811433618 PECOS PAC ID: 9537585609 Enrollment ID: I20200819003463 |
| Provider Name | Elizabeth R Harding |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043732274 PECOS PAC ID: 8022412808 Enrollment ID: I20210802003514 |
| Provider Name | David Newell Chiddix |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942635529 PECOS PAC ID: 6103183736 Enrollment ID: I20231020002391 |
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