Pettingill Counseling PC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

PETTINGILL COUNSELING PC

Practice address

1302 E 17TH St
Idaho Falls, ID 83404-6270

Phone

(208) 542-9919

Fax

(208) 542-6272

NPI assigned

Oct 13, 2023

Last updated

Oct 13, 2023By 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

Tamara Pettingill, LCSWNPI 1629081864

Title

Owner

Phone

(208) 227-4600

Specialties & licenses 1

Addresses

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.

• Tamara K. Pettingill, LCSW

  • Clinical Social Worker
  • Idaho Falls, ID
  • NPI 1629081864

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1697155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697155200000",
    "number": "1770365827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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 PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-13",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A",
        "authorized_official_last_name": "PETTINGILL",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-227-4600",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason M Peterson, DDS
• Jennifer Rae Peterson, LMSW
• Leon C Peterson, O.D.
• Marissa Peterson, MA/CCC-SLP
• Russell Henry Peterson, M.S.
• Pettingill Counseling Services
• Pettingill Counseling Services, PC
• Pettingill Counseling Services, Professional Corporation
• Pettingill Counseling Services, Professional Corporation
• Eric Vernon Pettingill, LCPC

• Mental Health Counselor in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2023; 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.