Provider Demographics
NPI:1639292626
Name:OSTERMILLER COUNSELING SERVICES INC.
Entity Type:Organization
Organization Name:OSTERMILLER COUNSELING SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:OSTERMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-359-9683
Mailing Address - Street 1:242 E 7TH N STE 4
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-3550
Mailing Address - Country:US
Mailing Address - Phone:208-359-9683
Mailing Address - Fax:208-359-9683
Practice Address - Street 1:242 E 7TH N STE 4
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3550
Practice Address - Country:US
Practice Address - Phone:208-359-9683
Practice Address - Fax:208-359-9683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
IDLCSW-1351261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806530400Medicaid
ID8J059OtherBLUE CROSS GROUP NUMBER
ID806867300Medicaid
ID000010151377OtherBLUE SHIELD GROUP #