NPIMap

Organization Active NPI

Clearwater Counseling

  • Social Worker
  • Moscow, ID
National Provider Identifier
1003937962
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Legal business name
CLEARWATER COUNSELING
Practice address
112 West 4TH #5
Moscow, ID 83843
Phone
(208) 882-9460
Fax
(208) 746-7402
NPI assigned
Apr 2, 2007
Last updated
Jun 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Authorized official

Name
Mark R Jones, LCSW
Title
Owner
Phone
(208) 743-8101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X Primary

Addresses

Primary practice location

112 West 4TH #5
Moscow, ID 83843

Mailing address

P.O. Box 1123
Lewiston, ID 83501
Phone (208) 743-8101

Other identifiers 1

IdentifierTypeStateIssuer
8073472MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Mark R Jones Dba Clearwater Counseling13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

112 W 4th St
Ste 5
Moscow, ID 83843
Phone (208) 882-9460

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1003937962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1123",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "83501",
            "telephone_number": "208-743-8101",
            "fax_number": "208-746-7402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 WEST 4TH #5",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "83843",
            "telephone_number": "208-882-9460",
            "fax_number": "208-746-7402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARWATER COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-743-8101",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8073472",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moscow, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.