Bevin Jay Modrak, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCPC4698 Issued in ID

Practice address

204 S Cole Rd
Boise, ID 83709-0934

Phone

(208) 319-9786

Fax

(208) 319-7773

NPI assigned

Dec 2, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Arrowrock Counseling and Consulting

  • Mental Health Counselor
  • Boise, ID
  • NPI 1912285891
  NPD Authorized official

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

{
    "created_epoch": "1322784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1326316514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6568 S FEDERAL WAY",
            "address_2": "#124",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837169277",
            "telephone_number": "208-283-9710",
            "fax_number": "208-319-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 S COLE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837090934",
            "telephone_number": "208-319-9786",
            "fax_number": "208-319-7773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODRAK",
        "first_name": "BEVIN",
        "middle_name": "JAY",
        "name_prefix": "Mr.",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-02",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LCPC4698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Moats, PT
• Mobileonedocs, LLC
• Dale L Mock, MD
• Joycelyn Modica, PT
• Jessie Modlin, PHARMD
• Kelsey Eileen Moe, PCP-NP
• Tawnya M Moeller, CST
• Katrin Hurley Moffett, PT
• Mofid Clinic of Chiropractic, LLC
• Afshin Mofid, D.C.

• Mental Health Counselor in Boise, ID
• Providers in Boise, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; 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.