Active NPI
Rebecca Fender, LPC
- Mental Health Counselor
- Moscow, ID
National Provider Identifier
1760120661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC-9182
- Practice address
- 805 N Main St Ste 109
Moscow, ID 83843-8513 - Phone
- (208) 310-4204
- NPI assigned
- May 22, 2022
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC-9182 | ID | Primary |
Addresses
Primary practice location
805 N Main St Ste 109
Moscow, ID 83843-8513
Mailing address
2609 Wildrose Dr
Moscow, ID 83843-4512
Phone (208) 310-6250
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-9182 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1760120661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2609 WILDROSE DR",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838434512",
"telephone_number": "208-310-6250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 N MAIN ST STE 109",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838438513",
"telephone_number": "208-310-4204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENDER",
"first_name": "REBECCA",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-22",
"last_updated": "2023-11-27",
"certification_date": "2023-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LPC-9182",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moscow, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.