Creswell Counseling Center LLC
Organization Active NPI Mental Health Counselor · Boise, ID
NPI 1962263897 · NPPES record last updated Feb 2, 2024
Key facts
- NPI
- 1962263897
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Legal business name
- CRESWELL COUNSELING CENTER LLC
- Practice address
- 4172 N Creswell Way
Boise, ID 83713-2403 - Phone
- (208) 863-1404
- Fax
- (833) 340-7217
- NPI assigned
- Jan 18, 2024
- Organization subpart
- No
Authorized official
- Name
- Rosemary Ladacy Luque, LCPC
- Title
- Business Owner/Provider
- Phone
- (208) 863-1404
Practitioners 1
-
Rosemary Ladacy Luque, LCPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240426000812 | ID | Part B Supplier - Clinic/Group Practice | 3971943754 |
Receives reassigned benefits from 1 practitioner Practice locations: Boise, ID |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | Yes |
Addresses
Primary practice location
4172 N Creswell Way
Boise, ID 83713-2403
Mailing address
4172 N Creswell Way
Boise, ID 83713-2403
Phone (208) 863-1404
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7365212 | Medicaid | ID | |
| 200000014376 | Other | ID | BLUE CROSS OF IDAHO |
Other providers in Boise, ID
- Rachael Ann Crawford
- Robert G Crawford
- Russell D Crawford
- Danielle Cremer
- Crescent Creek Therapy, LLC
- Judith Anne Crews
- Charlene A Crichton
- Rolf O Crichton
- Carey Dawn Crill
- Kristin Cripps
All providers in Boise, 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 2, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.