Jesse Altsuler
Individual provider Active NPI Professional Counselor · Rathdrum, ID
NPI 1306195128 · NPPES record last updated Sep 7, 2012
Key facts
- NPI
- 1306195128
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC-5047 (ID)
- Practice address
- 6852 W Silverado St
Rathdrum, ID 83858-8192 - Phone
- (208) 771-1466
- NPI assigned
- Sep 7, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-5047 | ID | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-5047 | ID | Yes |
Addresses
Primary practice location
6852 W Silverado St
Rathdrum, ID 83858-8192
Mailing address
6852 W Silverado St
Rathdrum, ID 83858-8192
Other providers in Rathdrum, ID
- Brooke Lynn Ackerman
- David Alverson
- At Home Physical Therapy Services, PLLC
- Brett Joseph Barna
- Joshua B Bartoo
- Duncan Bell
All providers in Rathdrum, ID · Professional Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.