Eric Scott Fernelius, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-37720 Issued in ID

Practice address

339 E 7TH N
Rexburg, ID 83440-5124

Phone

(801) 510-4750

NPI assigned

Apr 12, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Counseling & Treatment Center of Idaho

  • Clinical Social Worker
  • Rexburg, ID
  • NPI 1336885136
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651708800000",
    "number": "1154545093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 E 7TH N",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834405124",
            "telephone_number": "801-510-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 E 7TH N",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834405124",
            "telephone_number": "801-510-4750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 W Jackson Rd",
            "address_purpose": "LOCATION",
            "city": "Carrollton",
            "state": "TX",
            "postal_code": "750061316",
            "country_code": "US",
            "telephone_number": "972-242-2182",
            "fax_number": "972-242-2932",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERNELIUS",
        "first_name": "ERIC",
        "middle_name": "SCOTT",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-12",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "41939",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-37720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "86550Q",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Family Center Inc
• Family First Health Center of Rexburg Inc
• Cindi Farnworth, CRNA
• Kirsten Farnworth, OTR/L
• Rainey Alexandra Fernandez, LPC
• Erica Lynne Finney, LCSW
• First Steps Autism Center
• First Steps Autism Center
• Analee Fish, FNP
• Charles Florman, LPC

• Clinical Social Worker in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.