Apex Adventure Therapy

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

38122 Issued in ID

Legal business name

APEX ADVENTURE THERAPY

Doing business as

BlueFire Wilderness Therapy

Practice address

1832 E 1750 S
Gooding, ID 83330-5177

Phone

(208) 934-4444

Fax

(208) 934-5171

NPI assigned

Feb 26, 2015

Last updated

Aug 9, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Kathy Rex

Title

Executive Director

Phone

(208) 308-3163

Specialties & licenses 1

Addresses

Other names 1

• BlueFire Wilderness Therapy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lydia Jo Missal, LCPC

  • Professional Counselor
  • Hailey, ID
  • NPI 1083959332
  NPD (past)

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

{
    "created_epoch": "1424908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470700800000",
    "number": "1376935494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1832 E 1750 S",
            "city": "GOODING",
            "state": "ID",
            "postal_code": "833305177",
            "telephone_number": "208-934-4444",
            "fax_number": "208-934-5171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1832 E 1750 S",
            "city": "GOODING",
            "state": "ID",
            "postal_code": "833305177",
            "telephone_number": "208-934-4444",
            "fax_number": "208-934-5171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APEX ADVENTURE THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-26",
        "last_updated": "2016-08-09",
        "status": "A",
        "authorized_official_last_name": "REX",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "208-308-3163",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "ID",
            "license": "38122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BlueFire Wilderness Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 1 A Autumn Creek in Home Care (Autumn Creek In Home Care)
• Glen R Albertson Jr., M.D
• Joshua Dan Allen, PT, DPT
• Michael Anthoney
• Celina Arroyo
• Associates in Family Practice Inc
• Associates in Family Practice Inc
• Associates in Family Practice Inc
• Associates in Family Practice Inc

• Emotionally Disturbed Childrens' Residential Treatment Facility in Gooding, ID
• Providers in Gooding, ID by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2016; 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.