Canopy Behavioral Health, PLLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

CANOPY BEHAVIORAL HEALTH, PLLC

Practice address

750 W Ustick Rd Ste 120
Meridian, ID 83646-6133

Phone

(208) 273-9521

Fax

(208) 502-2538

NPI assigned

Dec 5, 2018

Last updated

Sep 26, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. John William Szudera, MS, LMFT, LCPCNPI 1457632218

Title

Owner/Clinical Director

Phone

(208) 273-9521

Specialties & licenses 4

Addresses

Electronic endpoints 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John William Szudera, LMFT, LCPC

  • Professional Counselor
  • Broomfield, CO
  • NPI 1457632218
  NPD Authorized official
• Megan Guillen Diaz, LMFT

  • Marriage & Family Therapist
  • Boise, ID
  • NPI 1457885824
  NPD (past)
• Stephanie Cherie Stuck, LCPC

  • Professional Counselor
  • Caldwell, ID
  • NPI 1205283314
  NPD (past)

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

{
    "created_epoch": "1543968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1861962698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "773 DEXTER DR",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800201509",
            "telephone_number": "208-273-9521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 W USTICK RD STE 120",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836466133",
            "telephone_number": "208-273-9521",
            "fax_number": "208-502-2538"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "80 Garden Ctr Ste 252",
            "address_purpose": "LOCATION",
            "city": "Broomfield",
            "state": "CO",
            "postal_code": "800201735",
            "country_code": "US",
            "telephone_number": "706-720-7508",
            "fax_number": "208-502-2538",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CANOPY BEHAVIORAL HEALTH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-05",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "SZUDERA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER/CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "208-273-9521",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS, LMFT, LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@canopybehavioralhealth.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "750 W Ustick Rd Ste 120",
            "city": "Meridian",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836466133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael M Cammann, DMD
• Andrew Scot Campbell
• Jennifer Campbell, RPH
• Pam Campbell, CADC
• Rachael Campbell
• R. Erik Cantwell, DDS
• Canyons Senior Living LLC
• Capitol Healthcare, Inc. (Horizon Homecare)
• Demitri Carahalios, PHYSICIAN ASSISTANT
• Christina Marie Carbonaro

• Professional Counselor in Meridian, ID
• Providers in Meridian, ID by specialty
• Professional Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.

Verify at the official NPI Registry.