Individual provider Active NPI

Katherine Elizabeth Medina-Guillen, L.P.C

  • Mental Health Counselor
  • Boise, ID
National Provider Identifier
1609116318
Registry record updated Sep 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LPC-5011 Issued in ID
Practice address
695 S El Blanco Dr
Boise, ID 83709-0423
Phone
(208) 440-3744
NPI assigned
Feb 18, 2013
Last updated
Sep 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LPC-5011 ID Primary

Addresses

Primary practice location

695 S El Blanco Dr
Boise, ID 83709-0423

Mailing address

8675 W Ardene St
Boise, ID 83709-2601
Phone (208) 780-3900

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

LicenseStateTypeSpecialty
LPC-5011IDMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Lifepath Services LLC CurrentSince Mar 1, 2024 Accepting new patients
Toni Sparks, PA PastSince Sep 12, 2016 Accepting new patients

Locations

8675 W Ardene St
Boise, ID 83709
Phone (208) 780-3900

Interoperability endpoints

  • Direct secure messaging: katherine.medina-guillen.1@30520.direct.athenahealth.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1361145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759104000000",
    "number": "1609116318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8675 W ARDENE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837092601",
            "telephone_number": "208-780-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 S EL BLANCO DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837090423",
            "telephone_number": "208-440-3744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA-GUILLEN",
        "first_name": "KATHERINE",
        "middle_name": "ELIZABETH",
        "credential": "L.P.C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-18",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LPC-5011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; 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.