Nicole Diana Madill-Klupenger, LCPC 6404

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LCPC-6404 Issued in ID

Practice address

687 Camp Nine Rd
Bonners Ferry, ID 83805-5074

Phone

(541) 314-5734

NPI assigned

Sep 12, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Nicole Diana Klupenger Former name

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

Specialty

Mental Health Counselor

Education

Other, 2011

Medicare assignment

May accept Medicare assignment

Group practices

Rawlings Community CounselingGroup PAC ID 8820222086, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Rawlings Community Counseling

  • Community/Behavioral Health Agency
  • Bonners Ferry, ID
  • NPI 1245528082

  Mental Health

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1473638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1366990996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "687 CAMP NINE RD",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838055074",
            "telephone_number": "541-314-5734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "687 CAMP NINE RD",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838055074",
            "telephone_number": "541-314-5734"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "687 Cody Street",
            "address_purpose": "LOCATION",
            "city": "Bonners Ferry",
            "state": "ID",
            "postal_code": "83805",
            "country_code": "US",
            "telephone_number": "208-267-0900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MADILL-KLUPENGER",
        "first_name": "NICOLE",
        "middle_name": "DIANA",
        "credential": "LCPC 6404",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-12",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LCPC-6404",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "LPC5539",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "KLUPENGER",
            "middle_name": "DIANA",
            "credential": "LCPC 6404",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jordan Thomas Lauby, PA-C
• Susan J Layeux, MD
• Carol V Lucero, LCSW
• Janet Marie Lukehart, MSN, FNP-BC
• Elisabeth M Mackey, ARNP
• Main Street Medical LLC
• Mark R. Barker, O.D.P.C.
• Jessica Martin, RN, BSN
• Alyssa Matthews, OTR/L
• Wendolyn E McClintock, R.D., L.D.

• Mental Health Counselor in Bonners Ferry, ID
• Providers in Bonners Ferry, 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 Jun 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.