Active NPI
Jacob W. Wilson, LCSW
- Clinical Social Worker
- Nampa, ID
National Provider Identifier
1114286648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW30132
- Practice address
- 824 S Diamond St
Nampa, ID 83686-5960 - Phone
- (208) 812-4999
- Fax
- (208) 634-4055
- NPI assigned
- May 3, 2012
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW30132 | ID | Primary |
Addresses
Primary practice location
824 S Diamond St
Nampa, ID 83686-5960
Mailing address
PO Box 2553
McCall, ID 83638-2553
Phone (208) 630-4040
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW30132 | ID | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Mountains Counseling, PLLC | Past | Accepting new patients |
Interoperability endpoints
- jacob.wilson.1@28563.direct.athenahealth.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- McCall, ID
- NPI 1841470887
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689120000000",
"number": "1114286648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2553",
"city": "MCCALL",
"state": "ID",
"postal_code": "836382553",
"telephone_number": "208-630-4040",
"fax_number": "208-634-4055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "824 S DIAMOND ST",
"city": "NAMPA",
"state": "ID",
"postal_code": "836865960",
"telephone_number": "208-812-4999",
"fax_number": "208-634-4055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JACOB",
"middle_name": "W.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-05-03",
"last_updated": "2023-07-12",
"certification_date": "2023-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW30132",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.