Active NPI
Terry Fredrickson
- Professional Counselor
- Pocatello, ID
National Provider Identifier
1962293795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- Practice address
- 33 Riverside Dr
Pocatello, ID 83204-4025 - Phone
- (208) 604-3933
- NPI assigned
- May 13, 2025
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | ID | Primary |
Addresses
Primary practice location
33 Riverside Dr
Pocatello, ID 83204-4025
Mailing address
101 S Main St
Pocatello, ID 83204-3210
Phone (208) 232-7807
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748044800000",
"number": "1962293795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 S MAIN ST",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832043210",
"telephone_number": "208-232-7807"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 RIVERSIDE DR",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832044025",
"telephone_number": "208-604-3933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDRICKSON",
"first_name": "TERRY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-05-13",
"last_updated": "2025-05-24",
"certification_date": "2025-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.