Dedra Christine Sanna, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCPC274 Issued in ID

Practice address

409 Washington Ave
Pocatello, ID 83201-4520

Phone

(208) 234-2646

Fax

(208) 232-0035

NPI assigned

Nov 14, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Dedra Christine Quinn Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bright Tomorrows Child Advocacy Center

  • Case Management Agency
  • Pocatello, ID
  • NPI 1174876205
  NPD (past)
• Bright Tomorrows, Incorporated

  • Adolescent and Children Mental Health Clinic/Center
  • Pocatello, ID
  • NPI 1619177797
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427328000000",
    "number": "1003097437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 WASHINGTON AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014520",
            "telephone_number": "208-234-2646",
            "fax_number": "208-232-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 WASHINGTON AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014520",
            "telephone_number": "208-234-2646",
            "fax_number": "208-232-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANNA",
        "first_name": "DEDRA",
        "middle_name": "CHRISTINE",
        "name_prefix": "Ms.",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-14",
        "last_updated": "2015-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LCPC274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEDRA",
            "last_name": "QUINN",
            "middle_name": "CHRISTINE",
            "prefix": "MRS.",
            "credential": "LCPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Yuting Salverson
• Julia Helene Sanders, OTD, OTR/L
• Anne Sandstad
• Curtis C Sandy, MD
• Chris A. Sanford, PHD
• Mickie Sant, LSW-24749
• Santa Clara Pediatrics & Behavioral Health PC
• Fernando Santana
• Christa Santos-Smith, LPC
• Jeannette M Sapp, LMSW/ CADC

• All providers in Pocatello, ID
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.