Active NPI
Brenda Pickett, LCSW
- Mental Health Counselor
- Eagle, ID
National Provider Identifier
1609917293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LCSW-826
- Practice address
- 136 S Academy Ave
Eagle, ID 83616-6541 - Phone
- (208) 794-4097
- NPI assigned
- Feb 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LCSW-826 | ID | Primary |
Addresses
Primary practice location
136 S Academy Ave
Eagle, ID 83616-6541
Mailing address
2674 W Deerfield CT
Eagle, ID 83616-2339
Phone (208) 794-4097
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 826 | Other | ID | LSCW |
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 |
|---|---|---|---|
| LCSW-826 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609917293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2674 W DEERFIELD CT",
"city": "EAGLE",
"state": "ID",
"postal_code": "836162339",
"telephone_number": "208-794-4097",
"fax_number": "208-939-9110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "136 S ACADEMY AVE",
"city": "EAGLE",
"state": "ID",
"postal_code": "836166541",
"telephone_number": "208-794-4097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICKETT",
"first_name": "BRENDA",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LCSW-826",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LSCW",
"identifier": "826",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.