Northwest Neurobehavioral Health, LLC
Organization Active NPI Clinical Social Worker · Meridian, ID
NPI 1013223445 · NPPES record last updated Aug 17, 2015
Key facts
- NPI
- 1013223445
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LCSW-28431 (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
- Organization subpart
- No
Authorized official
- Name
- Ms. Jennifer A La Jeunesse, LCSW, CMPE
- Title
- Co-Owner
- Phone
- (208) 283-9121
Corporate family (same tax ID) 1
Practitioners 59
-
James Andrew Carpenter, LMSW
-
Ann Marie Corey, N.P.
-
Laura Jo Curtis, LCSW
-
Paulette A Flores, PH.D.
-
Megan Elaine Laritchie, LCSW
-
Jeff Alan Sordahl Jr., PSY.D.
-
Alicia Williams, PSY.D
-
Eva Lisseth Davis, LCSW
-
Carolyn Suzanne Golden, PSY.D
-
Ryan Manwaring, DNP
-
Marcos Moreno, LCSW
-
Kelsy Newton, PSYD
-
Eric Edward Silk, PH.D.
-
Mark Alan Turner, MD
-
Juli Bohlman, PSYD
-
Meadow Marie Clerico, M.A.
-
Jeffrey Daniel Hall, PHD
-
Madeline Reeb, OTR/L
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110310000449 | ID | Part B Supplier - Clinic/Group Practice | 0446432512 |
Receives reassigned benefits from 19 practitioners Practice locations: Meridian, ID |
National Provider Directory
- Tax ID family
- Northwest Neurobehavioral Health
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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 | Yes |
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1369079 | Other | ID | MEDICARE PTAN |
Other providers in Meridian, ID
- Kaylee J Norman
- Jared S. Norseth
- North Fork Developmental Pediatrics, LLC
- Northpoint Recovery LLC
- Northwest Accident and Injury Clinic, LLC
- Northwest Neurobehavioral Health, LLC
- Erin Norton
- Julia Norton
- Nova Collective LLC
- Tia Nowacki
All providers in Meridian, ID · Clinical Social Worker in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.