NPIMap

Organization Active NPI

Northwest Neurobehavioral Health, LLC

  • Clinical Social Worker
  • Meridian, ID
National Provider Identifier
1013223445
Registry record updated Aug 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-28431 Issued in ID
Legal business name
NORTHWEST NEUROBEHAVIORAL HEALTH, LLC
Practice address
2076 S Eagle Rd
Meridian, ID 83642-6707
Phone
(208) 955-7333
NPI assigned
Aug 23, 2010
Last updated
Aug 17, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2015

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

Authorized official

Name
Ms. Jennifer A La Jeunesse, LCSW, CMPE
Title
Co-Owner
Phone
(208) 283-9121

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY-202425 ID
Clinical Psychologist 103TC0700X PSY-202505 ID
Social Worker 104100000X LMSW-29787 ID
Social Worker 104100000X LMSW-30636 ID
Clinical Social Worker 1041C0700X LCSW-28431 ID Primary
Speech-Language Pathologist 235Z00000X SLP-1687 ID

Addresses

Primary practice location

2076 S Eagle Rd
Meridian, ID 83642-6707

Mailing address

2076 S Eagle Rd
Meridian, ID 83642-6707
Phone (208) 955-7333

Other identifiers 1

IdentifierTypeStateIssuer
1369079OtherIDMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110310000449 ID Part B Supplier - Clinic/Group Practice 0446432512 Receives reassigned benefits from 19 practitioners
Practice locations: Meridian, ID

National Provider Directory

National Provider Directory
Tax ID family
Northwest Neurobehavioral Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

2463 E Gala St
Ste 100
Meridian, ID 83642
Phone (208) 955-7333

Practitioners & affiliated clinicians

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1282521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439769600000",
    "number": "1013223445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2076 S EAGLE RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426707",
            "telephone_number": "208-955-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2076 S EAGLE RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426707",
            "telephone_number": "208-955-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST NEUROBEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-23",
        "last_updated": "2015-08-17",
        "status": "A",
        "authorized_official_last_name": "LA JEUNESSE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "208-283-9121",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW, CMPE"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "PSY-202425",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "PSY-202505",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "LMSW-29787",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "LMSW-30636",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-28431",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ID",
            "license": "SLP-1687",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "1369079",
            "state": "ID"
        }
    ],
    "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 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.