Active NPI
Riley Fairgrieve, LPC
- Professional Counselor
- Boise, ID
National Provider Identifier
1720860810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-9829
- Practice address
- 816 W Bannock St Ste 201
Boise, ID 83702-5896 - Phone
- (208) 987-1436
- NPI assigned
- Oct 16, 2023
- Last updated
- Sep 3, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-9829 | ID | Primary |
Addresses
Primary practice location
816 W Bannock St Ste 201
Boise, ID 83702-5896
Mailing address
2014 S Division Ave
Boise, ID 83706-4211
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 |
|---|---|---|---|
| LPC-9829 | ID | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1697414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725321600000",
"number": "1720860810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2014 S DIVISION AVE",
"city": "BOISE",
"state": "ID",
"postal_code": "837064211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "816 W BANNOCK ST STE 201",
"city": "BOISE",
"state": "ID",
"postal_code": "837025896",
"telephone_number": "208-987-1436"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRGRIEVE",
"first_name": "RILEY",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-10-16",
"last_updated": "2024-09-03",
"certification_date": "2024-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LPC-9829",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 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.