Pacific Mental Health Idaho LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

PACIFIC MENTAL HEALTH IDAHO LLC

Practice address

1617 Cleveland Blvd
Caldwell, ID 83605-5029

Phone

(425) 582-2041

Fax

(425) 527-0468

NPI assigned

Jul 20, 2023

Organization subpart

No

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

Authorized official

Name

Jessy Hoag

Title

Credentialing Specialist

Phone

(425) 361-2273

Specialties & licenses 1

Addresses

Practitioners 1

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

• Jacquiline Medina, MA

  • Mental Health Counselor
  • Dallas, TX
  • NPI 1992534523
  NPD

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

{
    "created_epoch": "1689811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1710667142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5108 196TH ST SW STE 350",
            "address_2": "C/O RXDX MEDICAL BILLING SERVICES LLC, STE 310",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366169",
            "telephone_number": "425-361-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 CLEVELAND BLVD",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836055029",
            "telephone_number": "425-582-2041",
            "fax_number": "425-527-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC MENTAL HEALTH IDAHO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-20",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "HOAG",
        "authorized_official_first_name": "JESSY",
        "authorized_official_title_or_position": "CREDENTIALING  SPECIALIST",
        "authorized_official_telephone_number": "425-361-2273"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Edward Otoole, LMSW
• Todd M Otstot, PA-C
• Mary Lu Owens, LMSW
• P. Roman Burk DPM PC
• P. Roman Burk DPM, PC
• Jennifer Padilla, LPC
• Travis Lee Page, D.O.
• Destiny Palmer, LCSW
• Travis William Palmer, P.T.
• Zane O Palmer, DDS

• Mental Health Counselor in Caldwell, ID
• Providers in Caldwell, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; 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.