Lindsey Nichole Petrick, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

41681 Issued in ID

Practice address

13403 N Government Way Ste 319
Hayden, ID 83835-8905

Phone

(208) 755-1641

NPI assigned

Feb 3, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Flourish Counseling

  • Mental Health Counselor
  • Hayden, ID
  • NPI 1952988461
  NPD Authorized official

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1558953398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4926 N ORCHID LN",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158748",
            "telephone_number": "208-755-1641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13403 N GOVERNMENT WAY STE 319",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838358905",
            "telephone_number": "208-755-1641"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4926 N Orchid Ln",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838158748",
            "country_code": "US",
            "telephone_number": "208-755-1641",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "212 W Ironwood Dr Ste D2045",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838141403",
            "country_code": "US",
            "telephone_number": "208-755-1641",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "624 W Harrison Ave",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838145286",
            "country_code": "US",
            "telephone_number": "208-755-1641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRICK",
        "first_name": "LINDSEY",
        "middle_name": "NICHOLE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-03",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "41681",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "37776",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Coeurd'alene",
            "affiliation": "N",
            "endpointDescription": "Laptop: EHR of Simple Practice",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "212 W Ironwood Dr Ste D2045",
            "city": "Coeur D Alene",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838141403",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Coeurd'alene",
            "affiliation": "N",
            "endpointDescription": "EHR; Simple Practice & Website contact",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "624 W Harrison Ave",
            "city": "Coeur D Alene",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838145286",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Heather Penske, MS, CCC-SLP
• Periwinkle Children'S Therapy
• Peterson Place Afh Inc
• Chax Brandon Peterson, PHARM. D.
• Tracey Peterson, PHARM D
• Physioone
• Savannah Plath, ARNP
• Poot Counseling, LLC
• Betsy Dale Poot Poot, ARNP, RN
• Theresa A. Porcarelli, RDMS, RVT, RDCS

• Clinical Social Worker in Hayden, ID
• Providers in Hayden, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2022; 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.