Cody Brown
Individual provider Active NPI Mental Health Counselor · Fruitland, ID
NPI 1851766976 · NPPES record last updated Feb 21, 2025
Key facts
- NPI
- 1851766976
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- LH61136624 (WA)
- Practice address
- 1611 N Whitley Dr
Fruitland, ID 83619-2177 - Phone
- (208) 291-1020
- NPI assigned
- Dec 1, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250327000464 | WA | Practitioner - Mental Health Counselor | 6901329267 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5671 | ID | MD | Mental Health Counselor |
| LH61136624 | WA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Refresh Therapy, Inc | Current |
Accepting new patients | |
| Refresh Therapy, Inc | Mental Health | Past | Accepting new patients |
Locations
16114 E Indiana Ave
Ste 210
Spokane Valley, WA 99216
Phone (360) 215-3242
13505 NE 10th Ave
Vancouver, WA 98685
Phone (360) 433-9664
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 5671 | ID | |
| Mental Health Counselor | 101YM0800X | LH61136624 | WA | Yes |
Addresses
Primary practice location
1611 N Whitley Dr
Fruitland, ID 83619-2177
Mailing address
1611 N Whitley Dr
Fruitland, ID 83619-2177
Other practice location 1
13505 NE 10th Ave
Vancouver, WA 98685-2711
Phone (360) 433-9664
Other practice location 2
16114 E Indiana Ave Ste 210
Spokane Valley, WA 99216-1874
Phone (360) 433-9664
Other providers in Fruitland, ID
- Anne K Boster
- Lyle Spencer Bourcy
- Bourner Counseling Services
- Jared Anthony Bradford
- Charles Edward Brioschi Jr.
- Baylee Buckland
- Buena Vista Enterprises, Inc.
- Paige Bunker
- Emily Burnett
- Terry A. Buster
All providers in Fruitland, ID · Mental Health Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.