NPIMap

Organization Active NPI

Affect Therapeutics, Inc.

  • Mental Health Counselor
  • Nampa, ID
National Provider Identifier
1033857453
Registry record updated Aug 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
AFFECT THERAPEUTICS, INC.
Practice address
1217 3Rd St S Ste 109
Nampa, ID 83651-3917
Phone
(845) 769-8758
NPI assigned
May 25, 2022
Last updated
Aug 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2025

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

Authorized official

Name
Karla Renee Mullings
Title
Director Clinical Compliance
Phone
(323) 522-2218

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU
Nurse Practitioner 363L00000X NU
Adult Health Nurse Practitioner 363LA2200X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Mental Health Counselor 101YM0800X NU Primary
Professional Counselor 101YP2500X NU
Clinical Social Worker 1041C0700X NU
Marriage & Family Therapist 106H00000X NU

Addresses

Primary practice location

1217 3Rd St S Ste 109
Nampa, ID 83651-3917

Mailing address

520 Broadway FL 4
New York, NY 10012-4436

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250602002503 ID Part B Supplier - Clinic/Group Practice 4284071903 Receives reassigned benefits from 1 practitioner
Practice locations: Nampa, ID

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2274365Affect Therapeutics Inc1217 E 3Rd St Ste 109, Nampa, ID 83651Certificate of waiverJan 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Affect Therapeutics Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

1217 3rd St S
Ste 109
Nampa, ID 83651

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755129600000",
    "number": "1033857453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 BROADWAY FL 4",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100124436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 3RD ST S STE 109",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836513917",
            "telephone_number": "845-769-8758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFECT THERAPEUTICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-25",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A",
        "authorized_official_last_name": "MULLINGS",
        "authorized_official_first_name": "KARLA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "DIRECTOR CLINICAL COMPLIANCE",
        "authorized_official_telephone_number": "323-522-2218"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.