Corey L Richardson, LCSW
Individual provider Active NPI Clinical Social Worker · American Falls, ID
NPI 1285962779 · NPPES record last updated Jan 11, 2021
Key facts
- NPI
- 1285962779
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- IDAHO LCSW-28906 (ID)
- Practice address
- 745 Reed St
American Falls, ID 83211-1334 - Phone
- (208) 244-8771
- NPI assigned
- Nov 23, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gateway Counseling Incorporated
Practice addresses (Care Compare)
151 N 3Rd Ave
Suite 330
Pocatello, ID 83201-6369
Phone (208) 242-3771
745 Reed St
American Falls, ID 83211-1334
Phone (208) 244-8771
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110331000665 | ID | Practitioner - Clinical Social Worker | 4789867524 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IDAHO LCSW-28906 | ID | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Falls Family Counseling LLC | Clinical | Current |
Accepting new patients |
| Gateway Counseling Incorporated | Current |
Accepting new patients |
Locations
151 N 3rd Ave
Ste 330
Pocatello, ID 83201
Phone (208) 242-3771
224 S Arthur Ave
Ste 2
Pocatello, ID 83204
Phone (208) 242-3771
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | IDAHO LCSW-28906 | ID | Yes |
Addresses
Primary practice location
745 Reed St
American Falls, ID 83211-1334
Mailing address
745 Reed St
American Falls, ID 83211-1334
Phone (208) 244-8771
Other practice location 1
151 N 3rd Ave Ste 330
Pocatello, ID 83201-6369
Phone (208) 244-8771
Other practice location 2
5230 W Moonlight Mine Rd
Pocatello, ID 83201-9013
Phone (208) 244-8771
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 28906 | Other | ID | LCSW |
Other providers in American Falls, ID
- Power County Hospital District
- Power County Hospital District
- Power County Hospital District
- Power County Hospital District
- Josiah Brandt Price
- Ridley'S Family Markets, Inc
- Rockland Pharmacy, Inc
- Rockland Pharmacy, Inc
- Spencer Garrett Seibold
- Brock Shawver
All providers in American Falls, ID · Clinical Social Worker in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.