Individual provider Active NPI

Maria Gomez, LCSW

  • Clinical Social Worker
  • Idaho Falls, ID
National Provider Identifier
1710609987
Registry record updated Mar 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
8911144 Issued in ID
Practice address
2265 W Broadway St
Idaho Falls, ID 83402-2996
Phone
(208) 524-7400
Fax
(208) 524-8004
NPI assigned
Sep 14, 2022
Last updated
Mar 4, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 8911144 ID Primary

Addresses

Primary practice location

2265 W Broadway St
Idaho Falls, ID 83402-2996

Mailing address

2265 W Broadway St
Idaho Falls, ID 83402-2996
Phone (208) 524-7400

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250410001298 ID Practitioner - Mental Health Counselor 3274057369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2265 W Broadway St
Idaho Falls, ID 83402-2900

2265 W Broadway St
Idaho Falls, ID 83402-2996

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8911144IDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Tueller Counseling Inc CurrentSince Mar 3, 2025 Accepting new patients
Tueller Counseling Inc CurrentSince May 18, 2025 Accepting new patients

Locations

2265 W Broadway St
Idaho Falls, ID 83402
Phone (208) 524-7400

2275 W Broadway St
Ste G
Idaho Falls, ID 83402
Phone (208) 524-7400

295 N 3855 E
Rigby, ID 83442
Phone (208) 745-5205

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772582400000",
    "number": "1710609987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2265 W BROADWAY ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834022996",
            "telephone_number": "208-524-7400",
            "fax_number": "208-524-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2265 W BROADWAY ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834022996",
            "telephone_number": "208-524-7400",
            "fax_number": "208-524-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "MARIA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-14",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "8911144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.