NPIMap

Organization Active NPI

North Idaho Children's Mental Health, PLLC.

  • Clinical Social Worker
  • Sandpoint, ID
National Provider Identifier
1083773378
Registry record updated May 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-25493 Issued in ID
Legal business name
NORTH IDAHO CHILDREN'S MENTAL HEALTH, PLLC.
Practice address
1717 Ontario St
Sandpoint, ID 83864-9329
Phone
(208) 265-6798
Fax
(208) 263-8160
NPI assigned
Dec 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2010

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

Authorized official

Name
Ms. Kim Bendickson
Title
Office Manager
Phone
(208) 265-6798

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X LCSW-25493 ID Primary

Addresses

Primary practice location

1717 Ontario St
Sandpoint, ID 83864-9329

Mailing address

1717 W. Ontario St
Sandpoint, ID 83864-8268
Phone (208) 265-6798

Other identifiers 1

IdentifierTypeStateIssuer
806106400MedicaidID

Other names 1

  • NICMH Other name

National Provider Directory

National Provider Directory

Locations

1717 Ontario St
Sandpoint, ID 83864
Phone (208) 265-6798

1203 Michigan St
Ste A
Sandpoint, ID 83864
Phone (208) 263-8948

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273708800000",
    "number": "1083773378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 W. ONTARIO ST",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838648268",
            "telephone_number": "208-265-6798",
            "fax_number": "208-263-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 ONTARIO ST",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838649329",
            "telephone_number": "208-265-6798",
            "fax_number": "208-263-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH IDAHO CHILDREN'S MENTAL HEALTH, PLLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2010-05-13",
        "status": "A",
        "authorized_official_last_name": "BENDICKSON",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-265-6798",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-25493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806106400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NICMH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sandpoint, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2010; 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.