Active NPI
Tessa Peterson, LMSW
- Social Worker
- Saint Anthony, ID
National Provider Identifier
1831974740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LMSW-44058
- Practice address
- 335 E Main St Ste 3
Saint Anthony, ID 83445-1546 - Phone
- (208) 356-4900
- Fax
- (208) 624-4030
- NPI assigned
- Aug 29, 2023
- Last updated
- Jul 28, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | LMSW-44058 | ID | Primary |
Addresses
Primary practice location
335 E Main St Ste 3
Saint Anthony, ID 83445-1546
Mailing address
PO Box 18
Saint Anthony, ID 83445-0018
Phone (208) 356-4900
Other practice location 1
72 S 1st E Ste 103
Rexburg, ID 83440-1902
Phone (208) 356-4900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMSW-44058 | ID | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upper Valley Community Health Services Inc | Social Worker | Past | Accepting new patients |
| Upper Valley Community Health Services Inc | Social Worker | Past | Accepting new patients |
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.
-
dba Grand Peaks Behavioral Health
- Federally Qualified Health Center (FQHC)
- Saint Anthony, ID
- NPI 1396507190
Social Worker
-
dba Grand Peaks Behavioral Health
- Federally Qualified Health Center (FQHC)
- Rexburg, ID
- NPI 1457113250
Social Worker
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753660800000",
"number": "1831974740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 18",
"city": "SAINT ANTHONY",
"state": "ID",
"postal_code": "834450018",
"telephone_number": "208-356-4900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "335 E MAIN ST STE 3",
"city": "SAINT ANTHONY",
"state": "ID",
"postal_code": "834451546",
"telephone_number": "208-356-4900",
"fax_number": "208-624-4030"
}
],
"practiceLocations": [
{
"address_1": "72 S 1st E Ste 103",
"address_purpose": "LOCATION",
"city": "Rexburg",
"state": "ID",
"postal_code": "834401902",
"country_code": "US",
"telephone_number": "208-356-4900",
"fax_number": "208-372-1023",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSON",
"first_name": "TESSA",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-29",
"last_updated": "2025-07-28",
"certification_date": "2025-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ID",
"license": "LMSW-44058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Anthony, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.