Peregrine Corp, PC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCPC - 139 Issued in ID

Legal business name

PEREGRINE CORP, PC

Practice address

37 Highway 57
Priest River, ID 83856-6559

Phone

(208) 448-4855

Fax

(208) 448-2467

NPI assigned

Oct 9, 2009

Organization subpart

No

Name

Ms. Dorlea Ann Knizley, LPC

Title

Board President

Phone

(208) 448-4855

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 25, 2013.

{
    "created_epoch": "1255046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380067200000",
    "number": "1093040917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 205",
            "city": "PRIEST RIVER",
            "state": "ID",
            "postal_code": "838560205",
            "telephone_number": "208-448-4855",
            "fax_number": "208-448-2467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 HIGHWAY 57",
            "city": "PRIEST RIVER",
            "state": "ID",
            "postal_code": "838566559",
            "telephone_number": "208-448-4855",
            "fax_number": "208-448-2467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEREGRINE CORP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-09",
        "last_updated": "2013-09-25",
        "status": "A",
        "authorized_official_last_name": "KNIZLEY",
        "authorized_official_first_name": "DORLEA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "BOARD PRESIDENT",
        "authorized_official_telephone_number": "208-448-4855",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LCPC - 139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807375500",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "Q2776",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD",
            "identifier": "000010016976",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807348800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.