Active NPI
Jack A Venbrux, M.A., LCPC, LMHC
- Mental Health Counselor
- Coeur D Alene, ID
National Provider Identifier
1679759500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LCPC-6701
- Practice address
- 1103 W Ironwood Dr
Coeur D Alene, ID 83814-2604 - Phone
- (509) 336-5972
- NPI assigned
- Jan 10, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LH60249089 | WA | |
| Mental Health Counselor | 101YM0800X | LCPC-6701 | ID | Primary |
Addresses
Primary practice location
1103 W Ironwood Dr
Coeur D Alene, ID 83814-2604
Mailing address
1103 W Ironwood Dr
Coeur D Alene, ID 83814-2604
Phone (509) 336-5972
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LH60249089 | Other | WA | PROVIDER LICENSE WA STATE |
| LCPC-6701 | Other | ID | PROVIDER LICENSE STATE OF IDAHO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 28, 2024 through Feb 29, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC-6701 | ID | MD | Mental Health Counselor |
| LH60249089 | WA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Redeeming Hearts LLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Counselor
- Coeur D Alene, ID
- NPI 1700379443
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540425600000",
"number": "1679759500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1103 W IRONWOOD DR",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142604",
"telephone_number": "509-336-5972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1103 W IRONWOOD DR",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142604",
"telephone_number": "509-336-5972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VENBRUX",
"first_name": "JACK",
"middle_name": "A",
"credential": "M.A., LCPC, LMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-10",
"last_updated": "2018-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "LH60249089",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LCPC-6701",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROVIDER LICENSE WA STATE",
"identifier": "LH60249089",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROVIDER LICENSE STATE OF IDAHO",
"identifier": "LCPC-6701",
"state": "ID"
}
],
"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 Oct 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.