Idaho Psychological Resources LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

IDAHO PSYCHOLOGICAL RESOURCES LLC

Practice address

4433 Beverland Road
Mackay, ID 83251

Phone

(208) 588-5770

Fax

(208) 588-2984

NPI assigned

Apr 4, 2018

Last updated

Aug 22, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alexis Smith

Title

Adminstrator

Phone

(208) 604-5193

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

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.

• Jefferson H Kraczek, LCSW

  • Clinical Social Worker
  • Mackay, ID
  • NPI 1093087033
  Medicare reassignment NPD

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

{
    "created_epoch": "1522800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787356800000",
    "number": "1063918464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 402",
            "city": "MACKAY",
            "state": "ID",
            "postal_code": "832510402",
            "telephone_number": "208-588-2770",
            "fax_number": "208-588-2984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4433 BEVERLAND ROAD",
            "city": "MACKAY",
            "state": "ID",
            "postal_code": "83251",
            "telephone_number": "208-588-5770",
            "fax_number": "208-588-2984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO PSYCHOLOGICAL RESOURCES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-04",
        "last_updated": "2026-08-22",
        "certification_date": "2026-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_title_or_position": "ADMINSTRATOR",
        "authorized_official_telephone_number": "208-604-5193"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• County of Custer SCH Dist #182
• Custer County (South Custer Ambulance)
• Jefferson H Kraczek, LCSW
• Lost Rivers Medical Center (Mackay Clinic)
• Mountain High Shuttle LLC
• O-Bar Family Dental
• Lori Palmer

• Community/Behavioral Health Agency in Mackay, ID
• Providers in Mackay, ID by specialty
• Community/Behavioral Health Agency in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.