NPIMap

Organization Active NPI

Mental Wellness Clinic of Coeur D Alene

  • Community/Behavioral Health Agency
  • Coeur D Alene, ID
National Provider Identifier
1629429782
Registry record updated Jun 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MENTAL WELLNESS CLINIC OF COEUR D ALENE
Practice address
1105 W Ironwood Dr
Coeur D Alene, ID 83814-2613
Phone
(208) 676-1003
Fax
(208) 676-1009
NPI assigned
Jun 29, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2016

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

Authorized official

Name
Kelly Lagrou
Title
Owner
Phone
(208) 676-1003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1105 W Ironwood Dr
Coeur D Alene, ID 83814-2613

Mailing address

1105 W Ironwood Dr
Coeur D Alene, ID 83814-2613
Phone (208) 676-1003

National Provider Directory

National Provider Directory
Tax ID family
Mental Wellness Clinic of Coeur D Alene5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467158400000",
    "number": "1629429782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 W IRONWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142613",
            "telephone_number": "208-676-1003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 W IRONWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142613",
            "telephone_number": "208-676-1003",
            "fax_number": "208-676-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL WELLNESS CLINIC OF COEUR D ALENE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-29",
        "last_updated": "2016-06-29",
        "status": "A",
        "authorized_official_last_name": "LAGROU",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-676-1003"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur D Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; 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.