Stacy Nicole Luce, LCPC
Individual provider Active NPI Professional Counselor · Kootenai, ID
NPI 1114286358 · NPPES record last updated Aug 24, 2020
Key facts
- NPI
- 1114286358
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LCPC-6335 (ID)
- Practice address
- 404 Kootenai St
Kootenai, ID 83840-0276 - Phone
- (810) 845-4472
- NPI assigned
- May 9, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240108004972 | ID | Practitioner - Mental Health Counselor | 4385095959 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC-6335 | ID | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boundary Regional Community Health Center Inc | Current |
Accepting new patients | |
| Boundary Regional Community Health Center Inc | Current |
Accepting new patients | |
| Boundary Regional Community Health Center, Inc. | Current | Accepting new patients | |
| Boundary Regional Community Health Center, Inc. | Past | Accepting new patients |
Locations
6615 Comanche St
Bonners Ferry, ID 83805
Phone (208) 267-1718
6509 Highway 2
Ste 101
Priest River, ID 83856
Phone (208) 448-2321
1033 Baldy Mountain Rd
Sandpoint, ID 83864
Phone (208) 263-7101
810 N Sixth Ave
Sandpoint, ID 83864
Phone (208) 263-7101
Interoperability endpoints
- stacy.luce.p1@direct.kch.nextgenshare.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- stacy.luce.1@32745.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LCPC-6335 | ID | |
| Professional Counselor | 101YP2500X | LCPC-6335 | ID | Yes |
Addresses
Primary practice location
404 Kootenai St
Kootenai, ID 83840-0276
Mailing address
PO Box 203
Kootenai, ID 83840-0203
Phone (810) 845-4472
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114286358 | Medicaid | ID |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | sluce@kaniksuhealthservices.org |
Other providers in Kootenai, ID
All providers in Kootenai, ID · Professional Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.