Lighthouse for Recovery, LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LCSW 28016 Issued in ID

Legal business name

LIGHTHOUSE FOR RECOVERY, LLC

Practice address

1135 Yellowstone Ave
Suite D
Pocatello, ID 83201-5082

Phone

(208) 232-2908

Fax

(208) 232-5423

NPI assigned

Sep 5, 2011

Organization subpart

No

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

Authorized official

Name

Mr. William C. Slaven, LCSW, CADCNPI 1235437591

Title

Executive Director

Phone

(208) 237-3365

Specialties & licenses 1

Addresses

Practitioners 1

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

• William C. Slaven, LCSW, CADC

  • Clinical Social Worker
  • Pocatello, ID
  • NPI 1235437591
  NPD (past) Authorized official

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

{
    "created_epoch": "1315180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315180800000",
    "number": "1013298058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 W LINDEN AVE",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832022306",
            "telephone_number": "208-237-3365",
            "fax_number": "208-232-5423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 YELLOWSTONE AVE",
            "address_2": "SUITE D",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015082",
            "telephone_number": "208-232-2908",
            "fax_number": "208-232-5423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE FOR RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-05",
        "last_updated": "2011-09-05",
        "status": "A",
        "authorized_official_last_name": "SLAVEN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "208-237-3365",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW, CADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ID",
            "license": "LCSW 28016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Addiction (Substance Use Disorder) Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2011; 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.