MEDICARE: MR. THOMAS E. TUELLER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW-859	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740321314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS E. TUELLER LCSW

Provider Business Mailing Address
First Line	:	2275 W BROADWAY ST STE G
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-2902
Country	:	US
Telephone Number	:	208-524-7400
Fax Number	:	208-524-8004

Provider Business Practice Location Address
First Line	:	2275 W BROADWAY ST STE G
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-2902
Country	:	US
Telephone Number	:	208-524-7400
Fax Number	:	208-524-8004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	05/09/2022

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