Serenity Neuropsychology, PLLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY-202392 Issued in ID

Legal business name

SERENITY NEUROPSYCHOLOGY, PLLC

Practice address

2498 N Stokesberry PL Ste 150
Meridian, ID 83646-5150

Phone

(208) 957-5450

Fax

(208) 957-5292

NPI assigned

Nov 16, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Melody Lynn Snider, PHDNPI 1982734984

Title

Licensed Psychologist/Owner

Phone

(208) 957-5450

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 2

• SERENITY NEUROPSYCHOLOGY & COUNSELING Doing business as
• Dr M. Snider PLLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in ID2 enrollments

Enrollment records 2

Locations

Practitioners 6

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

• Melody L Snider, PHD

  • Clinical Neuropsychologist
  • Meridian, ID
  • NPI 1982734984
  Medicare reassignment NPD Authorized official
• Brandie Brigham, LCPC, LMFT

  • Professional Counselor
  • Meridian, ID
  • NPI 1942484944
  NPD (past)
• Jennifer Fishman, LCPC, NCC

  • Mental Health Counselor
  • Meridian, ID
  • NPI 1356596019
  NPD (past)
• Debbie Jordan, LCPC

  • Mental Health Counselor
  • Meridian, ID
  • NPI 1073660544
  NPD (past)
• Camilla J Pearson-Cafferty, LCPC

  • Counselor
  • Meridian, ID
  • NPI 1063569796
  NPD (past)
• Heidi Marie Lasser, LCPC

  • Mental Health Counselor
  • Phoenix, AZ
  • NPI 1982884110
  NPD (past)

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546992000000",
    "number": "1285815399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2498 N STOKESBERRY PL STE 150",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836465150",
            "telephone_number": "208-957-5450",
            "fax_number": "208-957-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2498 N STOKESBERRY PL STE 150",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836465150",
            "telephone_number": "208-957-5450",
            "fax_number": "208-957-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY NEUROPSYCHOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2019-01-09",
        "status": "A",
        "authorized_official_last_name": "SNIDER",
        "authorized_official_first_name": "MELODY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "208-957-5450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "ID",
            "license": "PSY-202392",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "PSY-202392",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1982734984",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "N6316",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010162954",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PIN",
            "identifier": "16200124",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SERENITY NEUROPSYCHOLOGY & COUNSELING",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SERENITY NEUROPSYCHOLOGY & COUNSELING",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dr M. Snider PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Clinical Neuropsychologist in Meridian, ID
• Providers in Meridian, ID by specialty
• Clinical Neuropsychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.