Big Lake Psychological Services, PC

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PSY-202671 Issued in ID

Legal business name

BIG LAKE PSYCHOLOGICAL SERVICES, PC

Practice address

1809 E Sherman Ave
Coeur D Alene, ID 83814-5873

Phone

(208) 665-9611

NPI assigned

Nov 26, 2012

Last updated

Jul 27, 2020By 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

Dr. Heather Rehil, PSY.D.

Title

Chief Psychologist

Phone

(208) 550-3165

Specialties & licenses 1

Addresses

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.

• Michael Ray Tilus, PSYD

  • Clinical Psychologist
  • Hardin, MT
  • NPI 1700963873
  NPD

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

{
    "created_epoch": "1353888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595808000000",
    "number": "1508100876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 W IRONWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142605",
            "telephone_number": "208-550-3165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 E SHERMAN AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838145873",
            "telephone_number": "208-665-9611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIG LAKE PSYCHOLOGICAL SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-26",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A",
        "authorized_official_last_name": "REHIL",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "CHIEF PSYCHOLOGIST",
        "authorized_official_telephone_number": "208-550-3165",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "ID",
            "license": "PSY-202671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BHG Lxxxvii, LLC (BHG Medical Services - Idaho)
• Brittany Tyson Bianchin, NP
• Robin Bianco, LCPC
• Scott David Bieber, D.O.
• Timothy Biediger, RPH
• Duncan Curran Biggin
• Nancy Cecelia Billington, M.S. LCPC LMFT
• Gary Bills, DDS
• Nicole Bilyeu
• Haylee Bingham, PHARMD

• Clinical Child & Adolescent Psychologist in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Clinical Child & Adolescent Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.