NPIMap

Organization Active NPI

Mental Wellness Clinic of Coeur D Alene

  • Specialist
  • Coeur D Alene, ID
National Provider Identifier
1376763474
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MENTAL WELLNESS CLINIC OF COEUR D ALENE
Practice address
500 N Government Way
Suite 100
Coeur D Alene, ID 83814-2913
Phone
(208) 676-1003
Fax
(208) 676-1009
NPI assigned
Apr 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Kelly Lagrou, BA
Title
Owner Program Manager
Phone
(208) 676-1003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

500 N Government Way
Suite 100
Coeur D Alene, ID 83814-2913

Mailing address

500 N Government Way
Suite 100
Coeur D Alene, ID 83814-2913
Phone (208) 676-1003

National Provider Directory

National Provider Directory
Tax ID family
Mental Wellness Clinic of Coeur D Alene5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1177891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376763474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N GOVERNMENT WAY",
            "address_2": "SUITE 100",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142913",
            "telephone_number": "208-676-1003",
            "fax_number": "208-676-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N GOVERNMENT WAY",
            "address_2": "SUITE 100",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142913",
            "telephone_number": "208-676-1003",
            "fax_number": "208-676-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL WELLNESS CLINIC OF COEUR D ALENE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAGROU",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER  PROGRAM MANAGER",
        "authorized_official_telephone_number": "208-676-1003",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur D Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.