Active NPI
Jared Roberts
- Professional Counselor
- Idaho Falls, ID
National Provider Identifier
1063923597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-6667
- Practice address
- 550 W Sunnyside Rd
Idaho Falls, ID 83402-4619 - Phone
- (208) 529-5777
- NPI assigned
- Oct 24, 2017
- Last updated
- Oct 24, 2017
- Sex
- Male
- Sole proprietor
- No
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 | LPC-6667 | ID | Primary |
Addresses
Primary practice location
550 W Sunnyside Rd
Idaho Falls, ID 83402-4619
Mailing address
550 W Sunnyside Rd
Idaho Falls, ID 83402-4619
Phone (208) 529-5777
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 |
|---|---|---|---|
| LPC-6667 | ID | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508803200000",
"number": "1063923597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 W SUNNYSIDE RD",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834024619",
"telephone_number": "208-529-5777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 W SUNNYSIDE RD",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834024619",
"telephone_number": "208-529-5777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "JARED",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-24",
"last_updated": "2017-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LPC-6667",
"primary": true
}
],
"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 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.