Active NPI
Kendra Jean Nielson
- Mental Health Counselor
- Meridian, ID
National Provider Identifier
1891447751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC-8629
- Practice address
- 1901 N Lakes PL Ste 150
Meridian, ID 83646-5939 - Phone
- (208) 890-7165
- NPI assigned
- Jan 21, 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-8629 | ID | Primary |
Addresses
Primary practice location
1901 N Lakes PL Ste 150
Meridian, ID 83646-5939
Mailing address
14331 Crego St
Caldwell, ID 83607-4815
Phone (208) 757-0067
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-8629 | ID | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fulfillment LLC | Current | Accepting new patients | |
| Fulfillment LLC | Mental Health | Current | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Caldwell, ID
- NPI 1679287296
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642723200000",
"number": "1891447751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14331 CREGO ST",
"city": "CALDWELL",
"state": "ID",
"postal_code": "836074815",
"telephone_number": "208-757-0067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 N LAKES PL STE 150",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836465939",
"telephone_number": "208-890-7165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIELSON",
"first_name": "KENDRA",
"middle_name": "JEAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-21",
"last_updated": "2022-01-21",
"certification_date": "2022-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LPC-8629",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.