Tanner Mitchell Nielsen, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY-203073 Issued in ID

Practice address

2105 Coronado St
Idaho Falls, ID 83404-7495

Phone

(208) 534-7881

Fax

(208) 203-7067

NPI assigned

Sep 22, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• 4 Pillars of Success LLC

  • Multi-Specialty Clinic/Center
  • Ammon, ID
  • NPI 1619134277
  Medicare reassignment NPD
• Ascend LLC

  • Psychiatry Physician
  • Idaho Falls, ID
  • NPI 1811514870
  Medicare reassignment NPD
• 4 Pillars of Success LLC

  • Clinic/Center
  • Ammon, ID
  • NPI 1457698565
  NPD

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

{
    "created_epoch": "1253577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781740800000",
    "number": "1346574464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 CORONADO ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047495",
            "telephone_number": "208-534-7881",
            "fax_number": "208-203-7067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 CORONADO ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047495",
            "telephone_number": "208-534-7881",
            "fax_number": "208-203-7067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "TANNER",
        "middle_name": "MITCHELL",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-22",
        "last_updated": "2026-06-18",
        "certification_date": "2026-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "PSY-203073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane Rae Nielsen, PA C
• Justin Nielsen
• Justin S. Nielsen, PAC
• Kathryn E Nielsen, NP
• Susan Kaye Nielsen, LMSW
• Robert Dee Nielson, DMD
• Peter Nieman, M.S. CCC-SLP
• Niguel Sante LLC
• Debra A Nilsson, M.S., CCC-SLP
• Ninergk, LLC

• Clinical Psychologist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Clinical Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.