Active NPI
Susan Marie Holasek, LCPC
- Professional Counselor
- Coeur D'Alene, ID
National Provider Identifier
1043425473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LCPC-205
- Practice address
- 190 Ironwood Center Drive
Coeur D'Alene, ID 83814 - Phone
- (208) 765-4509
- Fax
- (208) 665-7014
- NPI assigned
- May 11, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LCPC-205 | ID | Primary |
Addresses
Primary practice location
190 Ironwood Center Drive
Coeur D'Alene, ID 83814
Mailing address
190 Ironwood Center Drive
Coeur D'Alene, ID 83814
Phone (208) 765-4509
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0035305 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC-205 | ID | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215993600000",
"number": "1043425473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 IRONWOOD CENTER DRIVE",
"city": "COEUR D'ALENE",
"state": "ID",
"postal_code": "83814",
"telephone_number": "208-765-4509",
"fax_number": "208-665-7014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "190 IRONWOOD CENTER DRIVE",
"city": "COEUR D'ALENE",
"state": "ID",
"postal_code": "83814",
"telephone_number": "208-765-4509",
"fax_number": "208-665-7014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLASEK",
"first_name": "SUSAN",
"middle_name": "MARIE",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-11",
"last_updated": "2008-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LCPC-205",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0035305",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coeur D'Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.