Active NPI
Jamie Lynn Van, LPC
- Professional Counselor
- Boise, ID
National Provider Identifier
1336550169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC 5951
- Practice address
- 600 E Riverpark LN Ste 125
Boise, ID 83706-6661 - Phone
- (208) 850-9186
- NPI assigned
- May 14, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | LPC 5951 | ID | Primary |
Addresses
Primary practice location
600 E Riverpark LN Ste 125
Boise, ID 83706-6661
Mailing address
600 E Riverpark LN Ste 125
Boise, ID 83706-6661
Phone (208) 850-9186
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC 5951 | ID | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543968000000",
"number": "1336550169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 E RIVERPARK LN STE 125",
"city": "BOISE",
"state": "ID",
"postal_code": "837066661",
"telephone_number": "208-850-9186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 E RIVERPARK LN STE 125",
"city": "BOISE",
"state": "ID",
"postal_code": "837066661",
"telephone_number": "208-850-9186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN",
"first_name": "JAMIE",
"middle_name": "LYNN",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-05-14",
"last_updated": "2018-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LPC 5951",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.