NPIMap

Organization Active NPI

Raising Resilience Holistic Mental Wellness Inc

  • Clinical Social Worker
  • Coeur d'Alene, ID
National Provider Identifier
1497377469
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
RAISING RESILIENCE HOLISTIC MENTAL WELLNESS INC
Practice address
500 N Government Way Ste 300
Coeur D Alene, ID 83814-2976
Phone
(208) 273-9147
NPI assigned
May 13, 2020
Last updated
Sep 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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

Authorized official

Name
Navara D Reardon, LCSWNPI 1396274932
Title
Owner
Phone
(208) 651-0604

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Social Worker 104100000X NU
Clinical Social Worker 1041C0700X NU Primary
Marriage & Family Therapist 106H00000X NU

Addresses

Primary practice location

500 N Government Way Ste 300
Coeur D Alene, ID 83814-2976

Mailing address

500 N Government Way Ste 300
Coeur D Alene, ID 83814-2976
Phone (208) 273-9147

Other practice location 1

601 E Sherman Ave Ste 2B
Coeur D Alene, ID 83814-2770
Phone (208) 273-9147

Other practice location 2

610 W Hubbard St Ste 226
Coeur D Alene, ID 83814-2200
Phone (208) 651-0604

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220513002132 ID Part B Supplier - Clinic/Group Practice 5193102051 Receives reassigned benefits from 2 practitioners
Practice locations: Coeur D Alene, ID

National Provider Directory

National Provider Directory

Locations

500 N Government Way
Ste 300
Coeur D Alene, ID 83814
Phone (208) 273-9147

601 E Sherman Ave
Ste 2B
Coeur D Alene, ID 83814
Phone (208) 273-9147

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1589328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695168000000",
    "number": "1497377469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N GOVERNMENT WAY STE 300",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142976",
            "telephone_number": "208-273-9147",
            "fax_number": "208-930-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N GOVERNMENT WAY STE 300",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142976",
            "telephone_number": "208-273-9147"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 E Sherman Ave Ste 2B",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838142770",
            "country_code": "US",
            "telephone_number": "208-273-9147",
            "fax_number": "208-930-1811",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "610 W Hubbard St Ste 226",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838142200",
            "country_code": "US",
            "telephone_number": "208-651-0604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RAISING RESILIENCE HOLISTIC MENTAL WELLNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-13",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A",
        "authorized_official_last_name": "REARDON",
        "authorized_official_first_name": "NAVARA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-651-0604",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "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 Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.