Provider Demographics
NPI:1346708948
Name:TORRES, TEMOC RAFAEL (LCPC)
Entity type:Individual
Prefix:
First Name:TEMOC
Middle Name:RAFAEL
Last Name:TORRES
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 W CENTER ST
Mailing Address - Street 2:STE C102
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-4205
Mailing Address - Country:US
Mailing Address - Phone:208-881-3212
Mailing Address - Fax:208-973-4911
Practice Address - Street 1:845 W CENTER ST
Practice Address - Street 2:STE C102
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-4205
Practice Address - Country:US
Practice Address - Phone:208-881-3212
Practice Address - Fax:208-973-4911
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8321850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health