Healthy Place Counseling Pocatello LLC

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

HEALTHY PLACE COUNSELING POCATELLO LLC

Practice address

1023 Yellowstone Ave
Ste. J
Pocatello, ID 83201-4478

Phone

(208) 233-1276

Fax

(208) 233-0835

NPI assigned

Feb 15, 2007

Last updated

Feb 26, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kirk Korenke

Title

Owner

Phone

(208) 200-4818

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456444800000",
    "number": "1154464394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 YELLOWSTONE AVE",
            "address_2": "STE. J",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014478",
            "telephone_number": "208-233-1276",
            "fax_number": "208-233-0835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 YELLOWSTONE AVE",
            "address_2": "STE. J",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014478",
            "telephone_number": "208-233-1276",
            "fax_number": "208-233-0835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY PLACE COUNSELING POCATELLO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2016-02-26",
        "status": "A",
        "authorized_official_last_name": "KORENKE",
        "authorized_official_first_name": "KIRK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-200-4818"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807364700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Counselor in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2016; 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.