Individual provider Active NPI

Lynetta Ruth Hagler, LCSW

  • Mental Health Counselor
  • Idaho Falls, ID
National Provider Identifier
1316110273
Registry record updated Apr 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LCSW1367 Issued in ID
Practice address
1277 E 17TH St
Idaho Falls, ID 83404-6126
Phone
(208) 523-0787
Fax
(208) 523-3175
NPI assigned
Apr 10, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LCSW1367 ID Primary
Clinical Social Worker 1041C0700X LCSW1367 ID

Addresses

Primary practice location

1277 E 17TH St
Idaho Falls, ID 83404-6126

Mailing address

1277 E 17TH St
Idaho Falls, ID 83404-6126
Phone (208) 523-0787

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW1367IDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Foot & Ankle Specialists of Idaho, P.C. PastSince Dec 6, 2014 Accepting new patients
Ashton Memorial, Inc. Past Accepting new patients
Family Resource Centers of America Clinical PastSince Nov 5, 2009 Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1207785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207785600000",
    "number": "1316110273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1277 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046126",
            "telephone_number": "208-523-0787",
            "fax_number": "208-523-3175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1277 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046126",
            "telephone_number": "208-523-0787",
            "fax_number": "208-523-3175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGLER",
        "first_name": "LYNETTA",
        "middle_name": "RUTH",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-10",
        "last_updated": "2008-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LCSW1367",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW1367",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.