Active NPI
Caleb Idlett
- Counselor
- Longview, WA
National Provider Identifier
1245845593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- CG1106027
- Practice address
- 748 14TH Ave
Longview, WA 98632-2315 - Phone
- (360) 200-5419
- Fax
- (360) 200-6736
- NPI assigned
- Sep 14, 2020
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | CG1106027 | WA | Primary |
Addresses
Primary practice location
748 14TH Ave
Longview, WA 98632-2315
Mailing address
PO Box 2394
Longview, WA 98632
Phone (360) 200-5419
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2164312 | Medicaid | WA |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG1106027 | WA | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Core Health | Past | Accepting new patients |
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Longview, WA
- NPI 1639693781
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603929600000",
"number": "1245845593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2394",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "98632",
"telephone_number": "360-200-5419",
"fax_number": "360-200-6736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "748 14TH AVE",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986322315",
"telephone_number": "360-200-5419",
"fax_number": "360-200-6736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IDLETT",
"first_name": "CALEB",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-14",
"last_updated": "2020-10-29",
"certification_date": "2020-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "CG1106027",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2164312",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longview, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.