State of Mind Counseling and Wellness Center

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

License

4841 Issued in ID

Legal business name

STATE OF MIND COUNSELING AND WELLNESS CENTER

Practice address

141 N Palmetto Ave Unit 1626
Eagle, ID 83616-8066

Phone

(208) 939-3999

NPI assigned

May 22, 2012

Organization subpart

No

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

Authorized official

Name

Lynda SmithNPI 1811265325

Title

LPC

Phone

(208) 602-2293

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lynda Smith, LPC

  • Professional Counselor
  • Eagle, ID
  • NPI 1811265325
  NPD (past) Authorized official

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

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343347200000",
    "number": "1013277128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 W STATE ST STE D",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836164982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 N PALMETTO AVE UNIT 1626",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836168066",
            "telephone_number": "208-939-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MIND COUNSELING AND WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-22",
        "last_updated": "2012-07-27",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_title_or_position": "LPC",
        "authorized_official_telephone_number": "208-602-2293"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "ID",
            "license": "4841",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "ID",
            "license": "4841",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "ID",
            "license": "4841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sprouted Therapy
• St Lukes Regional Medical Center
• St. Luke'S Treasure Valley Pediatrics
• Allison Stafford
• Lukas Stashik
• Kathryn L Stednitz, DPT
• Jazmyne Stephens
• Brayden Stern
• Susanne L Stickler, MD
• Amanda Beth Wartner Stinger, M.D., M.P.H.

• Adolescent and Children Mental Health Clinic/Center in Eagle, ID
• Providers in Eagle, ID by specialty
• Adolescent and Children Mental Health Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2012; 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.