Healthcare Provider Details

I. General information

NPI: 1598012700
Provider Name (Legal Business Name): TUELLER COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 WEST BROADWAY SUITE G
IDAHO FALLS ID
83402
US

IV. Provider business mailing address

2275 WEST BROADWAY, SUITE G
IDAHO FALLS ID
83402
US

V. Phone/Fax

Practice location:
  • Phone: 208-524-7400
  • Fax: 208-524-8004
Mailing address:
  • Phone: 208-524-7400
  • Fax: 208-524-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberLPC2922
License Number StateID

VIII. Authorized Official

Name: JILL SMITH
Title or Position: BILLING
Credential:
Phone: 208-524-7400