Individual provider Active NPI

Jennifer Wade, COUNSELOR INTERN

  • Mental Health Counselor
  • Moscow, ID
National Provider Identifier
1356053409
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
317 W 6TH St Ste 208
Moscow, ID 83843-2387
Phone
(208) 882-3504
NPI assigned
Dec 20, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

317 W 6TH St Ste 208
Moscow, ID 83843-2387

Mailing address

421 E 6TH St Apt 3
Moscow, ID 83843-2954
Phone (713) 419-5888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240529003457 ID Practitioner - Mental Health Counselor 9830531318 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scott Community Care, PLLCGroup PAC ID 2567701618, 7 clinicians

Practice addresses (Care Compare)

317 W 6TH St
Suite 208
Moscow, ID 83843-2387
Phone (208) 882-3504

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Scott Community Care, PLLC CurrentSince Apr 1, 2024 Accepting new patients

Locations

317 W 6th St
Ste 208
Moscow, ID 83843
Phone (208) 882-3504

Organizations & group practices 1

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": "1671494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1356053409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 E 6TH ST APT 3",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838432954",
            "telephone_number": "713-419-5888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 W 6TH ST STE 208",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838432387",
            "telephone_number": "208-882-3504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "JENNIFER",
        "credential": "COUNSELOR INTERN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-20",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moscow, ID

Sources for this page

Verify at the official NPI Registry.