LAKE CITY COUNSELING CENTER (NPI# 1356981419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356981419 |
| Entity Type | Organization |
| Organization Name | LAKE CITY COUNSELING CENTER |
| Practice Address |
9705 N Shaw St Hayden ID 83835-9716 |
| Practice Telephone | 2086259981 |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2020-01-07 |
| Authorized Official Name | JENNIFER RIAN TUTTLE (OWNER) |
| Authorized Official Telephone | 2088192716 |
| Is Organization Subpart | Y |
| Parent Organization Name | PEER SUPPORT |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 1720513963 | 05 |
| Other Name | Type Code |
|---|---|
| Peer Support | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972143048 | Lake City Counseling Center | Community/Behavioral Health | 9705 N Shaw St, Hayden, ID 83835-9716 | 2020-01-07 |
| 1962042036 | Lake City Counseling Center | Case Management | 9705 N Shaw St, Hayden, ID 83835-9716 | 2020-01-07 |
| Street Address |
9705 N SHAW ST |
| City | HAYDEN |
| State | ID |
| Zip Code | 83835-9716 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609158781 | Jennifer Rian Tuttle | Social Worker | 9705 N Shaw St, Hayden, ID 83835-9716 | 2011-09-14 |
| 1972143048 | Lake City Counseling Center | Community/Behavioral Health | 9705 N Shaw St, Hayden, ID 83835-9716 | 2020-01-07 |
| 1962042036 | Lake City Counseling Center | Case Management | 9705 N Shaw St, Hayden, ID 83835-9716 | 2020-01-07 |
| 1720513963 | Lake City Counseling Center LLC | Social Worker | 9705 N Shaw St, Hayden, ID 83835-9716 | 2017-04-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881212371 | Ngan T Nguyen | Pharmacist | 161 E. Prairie Shopping Center, Hayden, ID 83835 | 2020-07-10 |
| 1689158461 | Rskiom, Pllc | Electrodiagnostic Medicine | 9323 N Government Way #6, Hayden, ID 83835 | 2018-09-18 |
| 1235616913 | Kimberly Jill Young | Dietitian, Registered | 8500 N. Atlas Rd., Hayden, ID 83835 | 2018-07-25 |
| 1851894380 | Medicine Man North Pharmacy Inc | Pharmacy | 30585 N Roberts Rd, Hayden, ID 83835 | 2018-03-11 |
| 1366997322 | Jennifer Amber Belmont | Social Worker | 8680 N Wayne Dr, Suite A, Hayden, ID 83835 | 2016-08-19 |
| 1548637994 | Dance Dentistry Pllc | Clinic/Center | 1027 W Prairie Ave, Hayden, ID 83835 | 2015-09-01 |
| 1982012498 | Dallin J. Dance | Dentist | 1027 W. Prairie Ave., Hayden, ID 83835 | 2014-07-28 |
| 1669808614 | Integrated Interventions LLC | Clinic/Center | 2482 E. Glacier Rd., Hayden Lake, ID 83835 | 2013-09-23 |
| 1669812301 | Caleb Jerome Foss | Physical Therapist | 8382 N Wayne Dr Ste 100, Hayden, ID 83835 | 2013-06-26 |
| 1437493798 | Joseph Neal Tessendorf | Chiropractor | 1401 Biztown Loop, Hayden, ID 83835 | 2012-11-26 |
| Find all providers in zip 83835 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639779523 | Tracie Lyn Hansen | Peer Specialist | 560 Fairway Dr, Pocatello, ID 83201-2012 | 2020-10-29 |
| 1306481817 | Ability Health and Rehabilitation LLC | Peer Specialist | 10101 W Overland Rd Ste 110, Boise, ID 83709-1429 | 2019-11-08 |
| 1609426923 | Amie Hughes | Peer Specialist | 4737 S Afton Pl Ste A, Chubbuck, ID 83202-2317 | 2019-09-18 |
| 1184113482 | Kolleen Marie Wynn-gallipeau | Peer Specialist | 444 Hospital Way Ste 447, Pocatello, ID 83201-2744 | 2018-05-02 |
| 1073127791 | Calm Waters Counseling Pllc | Peer Specialist | 10108 W Overland Rd Ste A, Boise, ID 83709-1428 | 2020-09-01 |
| 1790307890 | Jx2 LLC | Peer Specialist | 8950 W Emerald St Ste 178, Boise, ID 83704-8296 | 2020-05-12 |
| 1063034437 | Inroads, Inc | Peer Specialist | 3288 E Pine Ave, Meridian, ID 83642-5922 | 2020-05-08 |
| 1356962112 | Aaa American Healthcare LLC | Peer Specialist | 1301 E 17th St, Idaho Falls, ID 83404-6273 | 2020-05-04 |
| 1346878691 | Aspen Ministries Syringa Wellness | Peer Specialist | 1609 S Kimball Ave Ste 200, Caldwell, ID 83605-5196 | 2020-03-31 |
| 1962033399 | Lookout Behavioral Health LLC | Peer Specialist | 7905 N Meadowlark Way Ste A, Coeur D Alene, ID 83815-5041 | 2020-02-04 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.