NPIMap

Organization Active NPI

Creekside Counseling

  • Mental Health Counselor
  • Idaho Falls, ID
National Provider Identifier
1063574226
Registry record updated Oct 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
CREEKSIDE COUNSELING
Practice address
550 W Sunnyside Rd Ste 1
Idaho Falls, ID 83402-4619
Phone
(208) 529-5777
Fax
(208) 529-5778
NPI assigned
Dec 14, 2006
Last updated
Oct 15, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2013

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

Authorized official

Name
Janet O. Allen, ED.D, LCPCNPI 1457413205
Title
Clinical Director
Phone
(208) 529-5777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NP1094A ID
Mental Health Counselor 101YM0800X Primary
Clinical Psychologist 103TC0700X

Addresses

Primary practice location

550 W Sunnyside Rd Ste 1
Idaho Falls, ID 83402-4619

Mailing address

550 W Sunnyside Rd Ste 1
Idaho Falls, ID 83402-4619
Phone (208) 529-5777

National Provider Directory

National Provider Directory

Locations

550 W Sunnyside Rd
Ste 1
Idaho Falls, ID 83402
Phone (208) 529-5777

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381795200000",
    "number": "1063574226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 W SUNNYSIDE RD STE 1",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834024619",
            "telephone_number": "208-529-5777",
            "fax_number": "208-529-5778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 W SUNNYSIDE RD STE 1",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834024619",
            "telephone_number": "208-529-5777",
            "fax_number": "208-529-5778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2013-10-15",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "208-529-5777",
        "authorized_official_credential": "ED.D, LCPC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ID",
            "license": "NP1094A",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2013; 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.