Active NPI
Rose Mesa, LMFT
- Marriage & Family Therapist
- Pocatello, ID
National Provider Identifier
1578870127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- LMFT 4384
- Practice address
- 1745 Pocatello Creek Rd
Pocatello, ID 83201-2308 - Phone
- (208) 233-9383
- Fax
- (208) 233-2707
- NPI assigned
- Sep 2, 2010
- Last updated
- Sep 2, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | LMFT 4384 | ID | Primary |
Addresses
Primary practice location
1745 Pocatello Creek Rd
Pocatello, ID 83201-2308
Mailing address
1745 Pocatello Creek Rd
Pocatello, ID 83201-2308
Phone (208) 233-9383
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMFT 4384 | ID | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283385600000",
"number": "1578870127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1745 POCATELLO CREEK RD",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832012308",
"telephone_number": "208-233-9383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1745 POCATELLO CREEK RD",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832012308",
"telephone_number": "208-233-9383",
"fax_number": "208-233-2707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MESA",
"first_name": "ROSE",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-02",
"last_updated": "2010-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "ID",
"license": "LMFT 4384",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.