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General NPI Number Information
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NPI Number | 1942166277
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Entity Type | Organization
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Legal Business Name | WIXOM COUNSELING ONLINE
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 4344 E NIBLEY CIR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3783
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Country | US
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Telephone | 208-521-4433
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Fax | 208-538-2233
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Provider Business Mailing Address
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Address Line | 4344 E NIBLEY CIR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3783
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Country | US
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Telephone | 208-521-4433
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Fax | 208-538-2233
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRET V WIXOM
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Credential | MSW LCSW
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Telephone | 208-521-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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