Individual provider Active NPI

Richard Harold Degraw, LCPC

  • Professional Counselor
  • Rexburg, ID
National Provider Identifier
1275014045
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LCPC-7843 Issued in ID
Practice address
393 E 2ND N
Rexburg, ID 83440-1605
Phone
(208) 359-4840
Fax
(208) 359-9010
NPI assigned
Aug 28, 2018
Last updated
May 15, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LCPC-7843 ID Primary

Addresses

Primary practice location

393 E 2ND N
Rexburg, ID 83440-1605

Mailing address

393 E 2ND N
Rexburg, ID 83440-1605
Phone (208) 359-4840

Other practice location 1

3453 Clearview Ln
Ammon, ID 83406-4702
Phone (208) 359-4840

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240208000319 ID Practitioner - Mental Health Counselor 7214370147 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centerpoint Counseling Services LLCGroup PAC ID 1456754373, 12 clinicians

Practice addresses (Care Compare)

393 E 2ND
Rexburg, ID 83440-1605
Phone (208) 359-4840

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCPC-7843IDMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Centerpoint Counseling Services, LLC Professional CurrentSince Jan 1, 2024 Accepting new patients

Locations

3453 Clearview Ln
Ammon, ID 83406
Phone (208) 359-4840

393 E 2nd N
Rexburg, ID 83440
Phone (208) 356-5401

393 E 2nd N
Bsmt
Rexburg, ID 83440

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1535414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1275014045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 E 2ND N",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401605",
            "telephone_number": "208-359-4840",
            "fax_number": "208-359-9010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "393 E 2ND N",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401605",
            "telephone_number": "208-359-4840",
            "fax_number": "208-359-9010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3453 Clearview Ln",
            "address_purpose": "LOCATION",
            "city": "Ammon",
            "state": "ID",
            "postal_code": "834064702",
            "country_code": "US",
            "telephone_number": "208-359-4840",
            "fax_number": "208-359-9010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEGRAW",
        "first_name": "RICHARD",
        "middle_name": "HAROLD",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-28",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "LCPC-7843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

Verify at the official NPI Registry.