Active NPI
Gary W Lee, LCSW
- Clinical Social Worker
- Meridian, ID
National Provider Identifier
1003963638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW578
- Practice address
- 1965 S Eagle Rd
Ste 140
Meridian, ID 83642-9288 - Phone
- (208) 957-6514
- Fax
- (208) 957-6506
- NPI assigned
- Jan 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW578 | ID | Primary |
Addresses
Primary practice location
1965 S Eagle Rd
Ste 140
Meridian, ID 83642-9288
Mailing address
1965 S Eagle Rd
Ste 140
Meridian, ID 83642-9288
Phone (208) 957-6514
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010015750 | Other | ID | REGENCE BLUE SHIELD OF ID |
| L9982 | Other | ID | BLUE CROSS OF IDAHO |
| 077063 | Other | NY | VALUE OPTIONS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW578 | ID | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Zelus Recovery LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Meridian, ID
- NPI 1376098533
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470355200000",
"number": "1003963638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1965 S EAGLE RD",
"address_2": "STE 140",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836429288",
"telephone_number": "208-957-6514",
"fax_number": "208-957-6506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1965 S EAGLE RD",
"address_2": "STE 140",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836429288",
"telephone_number": "208-957-6514",
"fax_number": "208-957-6506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "GARY",
"middle_name": "W",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-04",
"last_updated": "2016-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW578",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD OF ID",
"identifier": "000010015750",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "L9982",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "077063",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.