Active NPI
Mikayla Forrest, LCPC
- Professional Counselor
- Nampa, ID
National Provider Identifier
1710111638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5388
- Practice address
- 1015 Caldwell Blvd
Nampa, ID 83651-1717 - Phone
- (208) 353-4173
- NPI assigned
- May 6, 2009
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5388 | ID | Primary |
Addresses
Primary practice location
1015 Caldwell Blvd
Nampa, ID 83651-1717
Mailing address
712 9TH Ave S
Nampa, ID 83651-4540
Phone (208) 353-4173
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 |
|---|---|---|---|
| 5388 | ID | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400198400000",
"number": "1710111638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "712 9TH AVE S",
"city": "NAMPA",
"state": "ID",
"postal_code": "836514540",
"telephone_number": "208-353-4173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1015 CALDWELL BLVD",
"city": "NAMPA",
"state": "ID",
"postal_code": "836511717",
"telephone_number": "208-353-4173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORREST",
"first_name": "MIKAYLA",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-05-06",
"last_updated": "2014-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "5388",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.