Provider Demographics
NPI:1326106238
Name:FREE SPIRIT COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:FREE SPIRIT COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARYL
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRUGOLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-524-3373
Mailing Address - Street 1:548 LOMAX STREET
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401
Mailing Address - Country:US
Mailing Address - Phone:208-524-3733
Mailing Address - Fax:208-524-3738
Practice Address - Street 1:548 LOMAX STREET
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401
Practice Address - Country:US
Practice Address - Phone:208-524-3733
Practice Address - Fax:208-524-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID516167OtherVALUEOPTIONS
ID000010156871OtherREGENCE BLUESHIELD
ID8M829OtherBLUECROSS