Open Trails Counseling and Consulting PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

OPEN TRAILS COUNSELING AND CONSULTING PLLC

Practice address

2539 Channing Way Ste 100
Idaho Falls, ID 83404-7558

Phone

(208) 538-3450

NPI assigned

Mar 19, 2020

Last updated

Jul 23, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joanna L Trussel Berg, LCSWNPI 1629294897

Title

Owner/Executive Director

Phone

(208) 521-9946

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joanna Laree Trussel Berg, LCSW

  • Clinical Social Worker
  • Idaho Falls, ID
  • NPI 1629294897
  NPD Authorized official

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

{
    "created_epoch": "1584576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1619503893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 372",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834420372",
            "telephone_number": "208-521-9946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2539 CHANNING WAY STE 100",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047558",
            "telephone_number": "208-538-3450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4120 E 200 N",
            "address_purpose": "LOCATION",
            "city": "Rigby",
            "state": "ID",
            "postal_code": "834425975",
            "country_code": "US",
            "telephone_number": "208-538-3450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPEN TRAILS COUNSELING AND CONSULTING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-19",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "TRUSSEL BERG",
        "authorized_official_first_name": "JOANNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "208-521-9946",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Idaho Falls, ID
• Providers in Idaho Falls, 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 Jul 23, 2024; 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.