Active NPI
Kimberly S Lee, LCSW
- Clinical Social Worker
- Coeur D Alene, ID
National Provider Identifier
1073864013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-36216
- Practice address
- 2101 N Lakewood Dr Ste 220
Coeur D Alene, ID 83814-2473 - Phone
- (208) 699-9065
- Fax
- (208) 620-3994
- NPI assigned
- Oct 1, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LCSW-36216 | ID | |
| Clinical Social Worker | 1041C0700X | LCSW-36216 | ID | Primary |
Addresses
Primary practice location
2101 N Lakewood Dr Ste 220
Coeur D Alene, ID 83814-2473
Mailing address
PO Box 3415
Hayden, ID 83835-3415
Phone (208) 699-9065
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2024 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-36216 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606694400000",
"number": "1073864013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3415",
"city": "HAYDEN",
"state": "ID",
"postal_code": "838353415",
"telephone_number": "208-699-9065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 N LAKEWOOD DR STE 220",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142473",
"telephone_number": "208-699-9065",
"fax_number": "208-620-3994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "KIMBERLY",
"middle_name": "S",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-01",
"last_updated": "2020-11-30",
"certification_date": "2020-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LCSW-36216",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW-36216",
"primary": true
}
],
"identifiers": [],
"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 Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.