Jeremiah Guidos, LCPC
Individual provider Active NPI Professional Counselor · Heron, MT
NPI 1508299538 · NPPES record last updated Jul 25, 2014
Key facts
- NPI
- 1508299538
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- SWP-LCPC-LIC-8307 (MT)
- Practice address
- 26 Aspen Lane
Heron, MT 59844 - Phone
- (406) 847-5095
- NPI assigned
- Aug 13, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR, ID
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240115001515 | OR | Practitioner - Mental Health Counselor | 9032561113 | Reassigns benefits to 1 organization |
| I20240216004124 | ID | Practitioner - Mental Health Counselor | 9032561113 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC 5633 | ID | MD | Professional Counselor |
| SWP-LCPC-LIC-8307 | MT | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sokyahealth LLC | Professional | Current |
Accepting new patients |
| Healthy Perspectives Inc | Professional | Current |
Accepting new patients |
| Headlight Health Medical Group PLLC | Counselor | Current |
Accepting new patients |
| Sokyahealth Medical Group PC | Counselor | Current |
Accepting new patients |
Locations
348 W Parkcenter Blvd
Ste 120
Boise, ID 83706
1250 W Ironwood Dr
Ste 109
Coeur D Alene, ID 83814
1205 Highway 2
Ste 302
Sandpoint, ID 83864
Phone (208) 603-7514
700 NE Multnomah St
Ste 870
Portland, OR 97232
Phone (503) 238-5559
4800 S Macadam Ave
Ste 230
Portland, OR 97239
Phone (866) 657-6592
1827 NE 44th Ave
Ste 310
Portland, OR 97213
Phone (503) 298-4592
Interoperability endpoints
- jeremiah.guidos.p1@direct.sokya.nextgenshare.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LCPC 5633 | ID | |
| Professional Counselor | 101YP2500X | SWP-LCPC-LIC-8307 | MT | Yes |
Addresses
Primary practice location
26 Aspen Lane
Heron, MT 59844
Mailing address
PO Box 410
Heron, MT 59844-0410
Phone (406) 847-5095
Other providers in Heron, MT
- Clearview Horizon Inc
- Elk Mountain Academy
- Liliana Marie Hughes
- Christian K Johstoneaux
- Monarch School Inc.
- Jenna Neve
- Sawtooth Mountain EMS
All providers in Heron, MT · Professional Counselor in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.