Active NPI
David W. Roberts, LCPC
- Professional Counselor
- Pocatello, ID
National Provider Identifier
1710269170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LCPC-9221
- Practice address
- 335 N Main St
Pocatello, ID 83204 - Phone
- (208) 478-8340
- Fax
- (208) 478-8341
- NPI assigned
- Sep 12, 2011
- Last updated
- Dec 22, 2022
- Sex
- Male
- Sole proprietor
- No
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 | LCPC-9221 | ID | Primary |
Addresses
Primary practice location
335 N Main St
Pocatello, ID 83204
Mailing address
720 Washington St
Montpelier, ID 83254-1401
Phone (208) 220-4197
Other practice location 1
455 Washington St Ste 2
Montpelier, ID 83254-1600
Phone (208) 847-4464
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 |
|---|---|---|---|
| LCPC-9221 | ID | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fortify Family Counseling, LLC | Current | Accepting new patients | |
| Bear Lake County Memorial Hospital | Past | Accepting new patients |
Locations
720 Washington St
Montpelier, ID 83254
Phone (208) 220-4197
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Montpelier, ID
- NPI 1457031965
-
dba Bear Lake Family Care and OB/GYN
- Rural Health Clinic/Center
- Montpelier, ID
- NPI 1699057166
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671667200000",
"number": "1710269170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 WASHINGTON ST",
"city": "MONTPELIER",
"state": "ID",
"postal_code": "832541401",
"telephone_number": "208-220-4197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "335 N MAIN ST",
"city": "POCATELLO",
"state": "ID",
"postal_code": "83204",
"telephone_number": "208-478-8340",
"fax_number": "208-478-8341"
}
],
"practiceLocations": [
{
"address_1": "455 Washington St Ste 2",
"address_purpose": "LOCATION",
"city": "Montpelier",
"state": "ID",
"postal_code": "832541600",
"country_code": "US",
"telephone_number": "208-847-4464",
"fax_number": "208-847-3093",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROBERTS",
"first_name": "DAVID",
"middle_name": "W.",
"name_prefix": "Mr.",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-12",
"last_updated": "2022-12-22",
"certification_date": "2022-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LCPC-9221",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.