NPIMap

Organization Active NPI

Lake City Counseling Center

  • Peer Specialist
  • Hayden, ID
National Provider Identifier
1356981419
Registry record updated Jan 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
Legal business name
LAKE CITY COUNSELING CENTER
Practice address
9705 N Shaw St
Hayden, ID 83835-9716
Phone
(208) 625-9981
NPI assigned
Jan 7, 2020
Organization subpart
Yes
Parent organization
PEER SUPPORTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 7, 2020

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

Authorized official

Name
Jennifer Rian TuttleNPI 1609158781
Title
Owner
Phone
(208) 819-2716

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Peer SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 175T00000X Primary

Addresses

Primary practice location

9705 N Shaw St
Hayden, ID 83835-9716

Mailing address

9705 N Shaw St
Hayden, ID 83835-9716

Other identifiers 1

IdentifierTypeStateIssuer
1720513963MedicaidID

Other names 1

  • Peer Support Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL lakecitycounselingcenter@gmail.com

National Provider Directory

National Provider Directory
Tax ID family
Lake City Counseling Center3 organizations share this tax ID, including this one
Part of
Lake City Counseling Center

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1578355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578355200000",
    "number": "1356981419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9705 N SHAW ST",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838359716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9705 N SHAW ST",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838359716",
            "telephone_number": "208-625-9981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CITY COUNSELING CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEER SUPPORT",
        "enumeration_date": "2020-01-07",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A",
        "authorized_official_last_name": "TUTTLE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "RIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-819-2716"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720513963",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "lakecitycounselingcenter@gmail.com",
            "affiliation": "N",
            "address_1": "9705 N Shaw St",
            "city": "Hayden",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838359716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Peer Support",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hayden, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; 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.