Healthcare Provider Details

I. General information

NPI: 1548184096
Provider Name (Legal Business Name): TRESSA MARIAL HARTMANN LPC RI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 N 3966 E
RIGBY ID
83442-5772
US

IV. Provider business mailing address

193 N 3966 E
RIGBY ID
83442-5772
US

V. Phone/Fax

Practice location:
  • Phone: 208-360-3738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1771398
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: