Shayla Nicole Devisser, LCSW-44697

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-44697 Issued in ID

Practice address

6126 W. State Street
Boise, ID 83703

Phone

(208) 477-1202

NPI assigned

May 19, 2021

Sex

Female

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.

• Thrive With CBT - a Therapy Place

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boise, ID
  • NPI 1477407344
  NPD Authorized official
• A Body & Mind Health Services, LLC

  • Mental Health Counselor
  • Boise, ID
  • NPI 1326501305
  NPD (past)
• A Body & Mind Health Services, LLC

  • Mental Health Counselor
  • Boise, ID
  • NPI 1891396099
  NPD (past)

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

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1346814639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6126 W. STATE STREET",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837030932",
            "telephone_number": "208-477-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6126 W. STATE STREET",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83703",
            "telephone_number": "208-477-1202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8900 West Stirrup Street",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837098370",
            "country_code": "US",
            "telephone_number": "208-226-4973",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEVISSER",
        "first_name": "SHAYLA",
        "middle_name": "NICOLE",
        "credential": "LCSW-44697",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-19",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-44697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Devereux, RPH
• Justin Willis Devinaspre, NP
• Lauren Devine
• Stephanie Devine, RN
• Susan Devine, OT/L
• Angeline S Devitt, MD
• Michael John Devitt, PT
• Katherine Lynn Kaiser Devlin, ARNP
• Robert E. Devore, LPC
• Averianna M Deweese

• Clinical Social Worker in Boise, ID
• Providers in Boise, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; 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.