Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mrs. Tandice Peterson

Individual provider Professional Counselor · NPI 1104199074

Mrs. Tandice Peterson is a Professional Counselor in Pocatello, Idaho. Practices as a sole proprietor. Licensed in Idaho.

Licensed in
ID
In the registry since
2012
Specialties on file
2

Practice location Address checks out

1777 E Clark St Ste 210
Pocatello, ID 83201-3357
Phone: (208) 427-5891
Fax: (208) 427-5895
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X
Professional Counselor Taxonomy 101YP2500X · Licence LCPC-7004 (ID)

Record details

NPI number1104199074
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedFebruary 22, 2012
Last updated in NPPESJuly 11, 2023
Certification dateJuly 11, 2023

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