IDAHO DEPT OF HEALTH & WELFARE REG 1 AHM PSR SANDPOINT (NPI# 1417084716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417084716 |
| Entity Type | Organization |
| Organization Name | IDAHO DEPT OF HEALTH & WELFARE REG 1 AHM PSR SANDPOINT |
| Practice Address |
207 Larkspur St Ponderay ID 83852-5011 |
| Practice Telephone | 2082654535 |
| Practice Fax Number | 2082634198 |
| Mailing Telephone | 2082654535 |
| Mailing Fax Number | 2082634198 |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2016-08-25 |
| Authorized Official Name | HOLLY BONWELL (PROGRAM MANAGER) |
| Authorized Official Telephone | 2087691406 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BLUE SHIELD | 000010018348 | 01 | |
| ID | 8073518 | 05 | |
| BLUE CROSS OF IDAHO | HW256 | 01 |
| Street Address |
207 LARKSPUR ST |
| City | PONDERAY |
| State | ID |
| Zip Code | 83852-5011 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972084937 | Carol Young | Counselor | 207 Larkspur St, Ponderay, ID 83852-5011 | 2018-08-27 |
| 1215390158 | Joanna Richter | Registered Nurse | 207 Larkspur St, Ponderay, ID 83852-5011 | 2016-03-29 |
| 1407218209 | Barbara Thompson | Social Worker | 207 Larkspur St, Ponderay, ID 83852-5011 | 2016-03-22 |
| 1003277039 | Anna Louise Lawrence | Social Worker | 207 Larkspur St, Ponderay, ID 83852-5011 | 2016-03-18 |
| 1114388105 | Sadie Green | Social Worker | 207 Larkspur St, Ponderay, ID 83852-5011 | 2016-03-17 |
| 1265892210 | Elizabeth Larsen | Developmental Therapist | 207 Larkspur St, Ponderay, ID 83852-5011 | 2016-03-03 |
| 1801256227 | Susan Hansen | Developmental Therapist | 207 Larkspur St, Ponderay, ID 83852-5011 | 2016-02-26 |
| 1013239268 | Jennifer Smith | Marriage & Family Therapist | 207 Larkspur St, Ponderay, ID 83852-5011 | 2010-02-15 |
| 1467589184 | Idaho Dept of Health & Welfare Reg 1 Amh Clinic Sandpoint | Clinic/Center | 207 Larkspur St, Ponderay, ID 83852-5011 | 2007-02-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346606647 | Vern Stairs | Pharmacist | 476999 Us-95, Walmart Supercenter, Ponderay, ID 83852 | 2016-01-04 |
| 1083809727 | Michael R Dibenedetto Md Pllc | Orthopaedic Surgery | 30544 Hwy 200, Ste 102, Ponderay, ID 83852 | 2007-09-06 |
| 1811009988 | David Paul Cox | Dentist | 477542 Hwy 95 N, Ponderay, ID 83852 | 2006-08-31 |
| 1861774291 | Michael David Schicker | Orthopaedic Surgery | 30544 Highway 200 Ste 102, Ponderay, ID 83852 | 2011-09-12 |
| 1750410825 | Glacier Prosthetic Care, Inc. | Prosthetic/Orthotic Supplier | 205 Vermeer Dr, Suite C, Ponderay, ID 83852-1660 | 2007-03-05 |
| 1083949531 | Mario E Roxas | Naturopath | 476864 Highway 95, Suite #3, Ponderay, ID 83852-5000 | 2009-10-15 |
| 1942716246 | Darwin L Hurst | Family Medicine | 30544 Highway 200 Ste 101, Ponderay, ID 83852-5005 | 2017-12-21 |
| 1902036734 | Innovative Anesthesia | Nurse Anesthetist, Certified Registered | 30544 Highway 200 Ste 201, Pend Oreille Surgery Center, Ponderay, ID 83852-5005 | 2009-07-14 |
| 1255597811 | Travis Lee Taylor | Nurse Practitioner | 30544 Highway 200 Ste 102, Ponderay, ID 83852-5005 | 2008-08-04 |
| 1982741195 | Ryan Leisy | Chiropractor | 30544 Highway 200 Ste 330, Ponderay, ID 83852-5005 | 2007-01-30 |
| Find all providers in zip 83852 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598364978 | Brave Ahead Counseling | Clinic/Center | 991 Sunset Rd, Athol, ID 83801-9287 | 2020-10-18 |
| 1356959191 | Healing Minds LLC | Clinic/Center | 6586 W Flagstaff St, Rathdrum, ID 83858-8203 | 2020-07-17 |
| 1487273637 | Answers, LLC - Cbrs | Clinic/Center | 855 N Capital Ave Ste 1, Idaho Falls, ID 83402-3405 | 2020-04-08 |
| 1649808767 | Psychological Preventative Health Pllc | Clinic/Center | 4831 Greystone Ln, Idaho Falls, ID 83404-8338 | 2020-04-01 |
| 1073148623 | Begin Within Counseling, LLC | Clinic/Center | 943 W Overland Rd Ste 111, Meridian, ID 83642-6541 | 2020-03-04 |
| 1871126797 | Avanzar Wellness LLC | Clinic/Center | 11513 W Fairview Ave Ste 105, Boise, ID 83713-7887 | 2020-02-19 |
| 1174155741 | Noble Intent | Clinic/Center | 1406 N Main St Ste 204, Meridian, ID 83642-1746 | 2020-02-11 |
| 1194362517 | Advanced Counseling LLC | Clinic/Center | 39 W Pine Ave, Meridian, ID 83642-2281 | 2019-12-04 |
| 1629615406 | Building A Life Worth Living, LLC | Clinic/Center | 771 S Woodruff Ave, Idaho Falls, ID 83401-5286 | 2019-11-29 |
| 1750927281 | Weme Counseling and Clinical Consultation | Clinic/Center | 231 N Third Ave Ste 207, Sandpoint, ID 83864-1418 | 2019-11-19 |
| 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.