Quinn Blake Thibodeau, LPC, NCC, M. COUN

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC-4361 Issued in ID

Practice address

1891 Grandview CT
Idaho Falls, ID 83402-2510

Phone

(208) 681-7182

NPI assigned

May 27, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pearl Health ClinicGroup PAC ID 0840356077, 38 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Pearl Health Clinic

  • Mental Health Counselor
  • Ammon, ID
  • NPI 1447426465
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1243382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250035200000",
    "number": "1619102183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1891 GRANDVIEW CT",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834022510",
            "telephone_number": "208-681-7182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 GRANDVIEW CT",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834022510",
            "telephone_number": "208-681-7182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBODEAU",
        "first_name": "QUINN",
        "middle_name": "BLAKE",
        "credential": "LPC, NCC, M. COUN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-27",
        "last_updated": "2009-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LPC-4361",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Therapeutic House Calls, P.a.
• Therapeutic Shoes Inc
• Therapeutic Solutions
• Natalie M Theriault, L.AC
• Salina Thetford
• Jordan Thiel
• Kirk Thiemann
• Brittany M Thomas, CCC-SLP
• Michael Robert Thomas, PHD
• Sarah Thomas

• Mental Health Counselor in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.