Mountain West Supportive Services

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MOUNTAIN WEST SUPPORTIVE SERVICES

Practice address

1970 E 17TH St Ste 101
Idaho Falls, ID 83404-8046

Phone

(208) 715-0218

Fax

(208) 715-0210

NPI assigned

May 16, 2018

Organization subpart

No

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

Authorized official

Name

Kalle Stephanie Smith, LSW

Title

Owner

Phone

(208) 715-0218

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel James McIsaac, LCPC

  • Mental Health Counselor
  • Idaho Falls, ID
  • NPI 1710431242
  NPD (past)

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

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526428800000",
    "number": "1114417029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1970 E 17TH ST STE 101",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048046",
            "telephone_number": "208-715-0218",
            "fax_number": "208-715-0210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 E 17TH ST STE 101",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048046",
            "telephone_number": "208-715-0218",
            "fax_number": "208-715-0210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN WEST SUPPORTIVE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-16",
        "last_updated": "2018-05-16",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KALLE",
        "authorized_official_middle_name": "STEPHANIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-715-0218",
        "authorized_official_credential": "LSW"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mountain States Diabetes Relief, LLC
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• Mountain View Hospital LLC
• Mountain View Hospital Physician Organization
• Mountain West Ear Nose and Throat, PC
• Chantel NMN Mower, RN
• Mu Concepts LLC
• Kevin Richard Mudrow, D.D.S.
• Mueller Care Center, Inc.
• Kimberly Muhlestein

• Mental Health Clinic/Center (Including Community Mental Health Center) in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; 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.