Wild Life Community Counseling PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

WILD LIFE COMMUNITY COUNSELING PLLC

Practice address

264 Black Mountain Rd
Bonners Ferry, ID 83805-5308

Phone

(208) 416-3850

NPI assigned

May 26, 2022

Organization subpart

No

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

Authorized official

Name

Dean Michael Jennings, LCSWNPI 1831524537

Title

LCSW

Phone

(208) 416-3850

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dean Michael Jennings, LCSW

  • Clinical Social Worker
  • Bonners Ferry, ID
  • NPI 1831524537
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1653523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673395200000",
    "number": "1699413757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 172",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838050172",
            "telephone_number": "208-416-3850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 BLACK MOUNTAIN RD",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838055308",
            "telephone_number": "208-416-3850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD LIFE COMMUNITY COUNSELING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-26",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A",
        "authorized_official_last_name": "JENNINGS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "LCSW",
        "authorized_official_telephone_number": "208-416-3850",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adetta D Umphenour, LMSW
• Travis Medrano Walker, LPC
• Madicyn Weddington
• Kathryn L Wenzel, LCSW
• Robert B. Wenzel, LCPC
• Wildwood L.L.C
• Henry SK Willis IV, D.D.S.
• John Willis
• Stuart Kendall Willis III, MD
• William Lamont Worden, MD

• Clinical Social Worker in Bonners Ferry, ID
• Providers in Bonners Ferry, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.