Commonplace Wellness LLC
Organization Active NPI Mental Health Counselor · Boise, ID
NPI 1013745546 · NPPES record last updated May 18, 2025
Key facts
- NPI
- 1013745546
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Legal business name
- COMMONPLACE WELLNESS LLC
- Practice address
- 500 W Bannock St
Boise, ID 83702-5916 - Phone
- (208) 906-5878
- NPI assigned
- Jul 25, 2024
- Organization subpart
- No
Authorized official
- Name
- Issa Ntakarutimana, LCSW
- Title
- Owner / Clinician
- Phone
- (208) 906-5878
Practitioners 1
-
Issa Ntakarutimana, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241218001372 | ID | Part B Supplier - Clinic/Group Practice | 7113454943 |
Receives reassigned benefits from 1 practitioner Practice locations: Boise, ID |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | Yes | ||
| Clinical Social Worker |
1041C0700X |
Addresses
Primary practice location
500 W Bannock St
Boise, ID 83702-5916
Mailing address
205 S Bruce LN
Boise, ID 83712-7804
Other providers in Boise, ID
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- Alexander Combs
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All providers in Boise, ID · Mental Health Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2025. 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.