Active NPI
Thayne Andersen, LCSW
- Clinical Social Worker
- Fort Hall, ID
National Provider Identifier
1194909952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW-27518
- Practice address
- 717 Mission Road
Fort Hall, ID 83203-0306 - Phone
- (208) 237-5631
- Fax
- (208) 237-5796
- NPI assigned
- Dec 28, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | LCSW-27518 | ID | Primary |
Addresses
Primary practice location
717 Mission Road
Fort Hall, ID 83203-0306
Mailing address
PO Box 306
Fort Hall, ID 83203-0306
Phone (208) 237-5631
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 |
|---|---|---|---|
| LCSW-27518 | ID | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198800000000",
"number": "1194909952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 306",
"city": "FORT HALL",
"state": "ID",
"postal_code": "832030306",
"telephone_number": "208-237-5631",
"fax_number": "208-237-5796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "717 MISSION ROAD",
"city": "FORT HALL",
"state": "ID",
"postal_code": "832030306",
"telephone_number": "208-237-5631",
"fax_number": "208-237-5796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSEN",
"first_name": "THAYNE",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-28",
"last_updated": "2007-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW-27518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Hall, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.