Active NPI
Pettingill Counseling Services, Professional Corporation
- Counselor
- Idaho Falls, ID
National Provider Identifier
1194847285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LCSW-24477
- Legal business name
- PETTINGILL COUNSELING SERVICES, PROFESSIONAL CORPORATION
- Practice address
- 1302 E 17TH St
Idaho Falls, ID 83404-6270 - Phone
- (208) 542-9919
- Fax
- (208) 542-6272
- NPI assigned
- Apr 6, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Tamara K. Pettingill, LCSW
- Title
- Owner
- Phone
- (208) 542-9919
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LCSW-24477 | ID | Primary |
Addresses
Primary practice location
1302 E 17TH St
Idaho Falls, ID 83404-6270
Mailing address
2267 Teton PLZ
Idaho Falls, ID 83404-6486
Phone (208) 542-9919
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 806864000 | Medicaid | ID |
National Provider Directory
National Provider Directory- Tax ID family
- Pettingill Counseling Services PC
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Counselor
- Idaho Falls, ID
- NPI 1811913676
-
- Counselor
- Idaho Falls, ID
- NPI 1811019904
-
- Clinical Social Worker
- Idaho Falls, ID
- NPI 1891919890
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175817600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1671408000000",
"number": "1194847285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2267 TETON PLZ",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834046486",
"telephone_number": "208-542-9919",
"fax_number": "208-542-6272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1302 E 17TH ST",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834046270",
"telephone_number": "208-542-9919",
"fax_number": "208-542-6272"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PETTINGILL COUNSELING SERVICES, PROFESSIONAL CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-06",
"last_updated": "2022-12-19",
"certification_date": "2022-12-19",
"status": "A",
"authorized_official_last_name": "PETTINGILL",
"authorized_official_first_name": "TAMARA",
"authorized_official_middle_name": "K.",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "208-542-9919",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "LCSW"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor",
"state": "ID",
"license": "LCSW-24477",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "806864000",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
- Marissa Peterson, MA/CCC-SLP
- Russell Henry Peterson, M.S.
- Pettingill Counseling PC
- Pettingill Counseling Services
- Pettingill Counseling Services, PC
- Pettingill Counseling Services, Professional Corporation
- Eric Vernon Pettingill, LCPC
- Tamara K. Pettingill, LCSW
- Robert John Pettit, MD
- David Aaron Petty, D.O.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.