Active NPI
Nicholas Pack
- Marriage & Family Therapist
- Post Falls, ID
National Provider Identifier
1720731201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 1101 E Polston Ave Ste a
Post Falls, ID 83854-6045 - Phone
- (208) 981-0431
- NPI assigned
- Feb 3, 2022
- 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 | LAMFT-8468 | ID | |
| Marriage & Family Therapist | 106H00000X | ID | Primary |
Addresses
Primary practice location
1101 E Polston Ave Ste a
Post Falls, ID 83854-6045
Mailing address
1121 E Boyd Ave Apt a
Coeur D Alene, ID 83814-4384
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 |
|---|---|---|---|
| LAMFT-8468 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1643846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718582400000",
"number": "1720731201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1121 E BOYD AVE APT A",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838144384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 E POLSTON AVE STE A",
"city": "POST FALLS",
"state": "ID",
"postal_code": "838546045",
"telephone_number": "208-981-0431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACK",
"first_name": "NICHOLAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-02-03",
"last_updated": "2024-06-17",
"certification_date": "2024-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LAMFT-8468",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "ID",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Post Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.