Timothy Stephen Desantis, LCPC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LCPC-4671 Issued in ID

Practice address

8620 W Emerald St
Suite 150
Boise, ID 83704-4824

Phone

(208) 672-2900

Fax

(208) 672-2919

NPI assigned

May 7, 2013

Last updated

May 7, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367884800000",
    "number": "1861837601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 CHELSEY CIR",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836474634",
            "telephone_number": "208-672-8764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8620 W EMERALD ST",
            "address_2": "SUITE 150",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044824",
            "telephone_number": "208-672-2900",
            "fax_number": "208-672-2919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESANTIS",
        "first_name": "TIMOTHY",
        "middle_name": "STEPHEN",
        "name_prefix": "Mr.",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-07",
        "last_updated": "2013-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ID",
            "license": "LCPC-4671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Boise, ID
• Providers in Boise, ID by specialty
• Addiction (Substance Use Disorder) Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2013; 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.