Provider Demographics
NPI:1437585114
Name:PACIFIC RIM CONSULTING LLC
Entity type:Organization
Organization Name:PACIFIC RIM CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:208-232-8840
Mailing Address - Street 1:101 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-4321
Mailing Address - Country:US
Mailing Address - Phone:208-232-8840
Mailing Address - Fax:208-232-0925
Practice Address - Street 1:101 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-4321
Practice Address - Country:US
Practice Address - Phone:208-232-8840
Practice Address - Fax:208-232-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8067841Medicaid