MENTAL WELLNESS CLINIC OF COEUR D ALENE (NPI# 1619195344) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619195344 |
| Entity Type | Organization |
| Organization Name | MENTAL WELLNESS CLINIC OF COEUR D ALENE |
| Practice Address |
500 N Government Way Suite 100 Coeur D Alene ID 83814-2913 |
| Practice Telephone | 2086761003 |
| Practice Fax Number | 2086761009 |
| Mailing Telephone | 2086761003 |
| Mailing Fax Number | 2086761009 |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | KELLY P LAGROU (OWNER PROGRAM MANAGER) |
| Authorized Official Telephone | 2086761003 |
| Authorized Official Credential | BA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 171M00000X | Case Manager/Care Coordinator | Other Service Providers | ||
| X | 174400000X | Specialist | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598116659 | Mental Wellness Clinic of Coeur D Alene | Peer Specialist | 1105 W Ironwood Dr, Coeur D Alene, ID 83814-2613 | 2016-06-29 |
| 1629429782 | Mental Wellness Clinic of Coeur D Alene | Community/Behavioral Health | 1105 W Ironwood Dr, Coeur D Alene, ID 83814-2613 | 2016-06-29 |
| 1376763474 | Mental Wellness Clinic of Coeur D Alene | Specialist | 500 N Government Way, Suite 100, Coeur D Alene, ID 83814-2913 | 2007-04-30 |
| Street Address |
500 N GOVERNMENT WAY SUITE 100 |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83814-2913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376763474 | Mental Wellness Clinic of Coeur D Alene | Specialist | 500 N Government Way, Suite 100, Coeur D Alene, ID 83814-2913 | 2007-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477162675 | Dehra Mcfaddan | Social Worker | 211 E. Coeur D'alene Ave, 102, Coeur D Alene, ID 83814 | 2020-07-24 |
| 1043838634 | Yendi Labelle | Nurse Practitioner | 1115 N Ironwood Drive, Coeur D'alene, ID 83814 | 2020-07-09 |
| 1295353217 | Cultivation, LLC | Counselor | 211 E. Coeur Dalene Ave. Ste 102, Coeur D'alene, ID 83814 | 2020-07-07 |
| 1306487517 | Northwest Integrated Health, LLP | Clinic/Center | 1250 West N. Northwood Center Ct, Suite B, Coeur D'alene, ID 83814 | 2019-09-30 |
| 1730740465 | Connor Williams | Physical Therapist | 1812 W Lakewood Dr, Ste. 100, Coeur D Alene, ID 83814 | 2019-06-24 |
| 1912480153 | Nadine M Lewis | Social Worker | 211 E. Coeur D'alene Ave., Coeur D'alene, ID 83814 | 2018-09-13 |
| 1992208631 | Orthopedic Surgery and Sports | Orthopaedic Surgery | 1812 N Lakewood Drive, Suite 100, Coeur D'alene, ID 83814 | 2018-03-08 |
| 1346758042 | Heather Marie Johnson | Counselor | 7905 Meadowlark Way, Cda, ID 83814 | 2018-01-16 |
| 1881113413 | Brevity Treatment Services | Counselor | 2201 N. Government Way Ste. L, Coeur D'alene, ID 83814 | 2017-09-14 |
| 1366969628 | Jennifer La Gina Highfield | Massage Therapist | 1104 N Ste B, Coeur D Alene, ID 83814 | 2017-08-28 |
| Find all providers in zip 83814 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225433956 | Lori Petersen | Case Manager/Care Coordinator | 518 S 13th St, Coeur D Alene, ID 83814-3919 | 2014-10-23 |
| 1023411121 | Kelly Rodkey | Case Manager/Care Coordinator | 6795 N Mineral Dr, Coeur D Alene, ID 83815-8700 | 2014-10-02 |
| 1467796540 | Susan Marie Amaral | Case Manager/Care Coordinator | 2120 N Lakewood Dr Ste B, Coeur D Alene, ID 83814-2638 | 2012-11-15 |
| 1437759123 | Gregg Marshall | Case Manager/Care Coordinator | 2025 W Park Pl Ste B, Coeur D Alene, ID 83814-2787 | 2020-10-30 |
| 1447736137 | Patricia Reichert | Case Manager/Care Coordinator | 2201 Ironwood Pl, Coeur D Alene, ID 83814-2670 | 2018-07-16 |
| 1689150377 | Amanda Herfurth | Case Manager/Care Coordinator | 2205 Ironwood Pl Ste B, Coeur D Alene, ID 83814-2487 | 2018-07-16 |
| 1336539725 | Lap Inc | Case Manager/Care Coordinator | 518 S 13th St, Coeur D Alene, ID 83814-3919 | 2015-01-23 |
| 1457696551 | North Idaho College | Case Manager/Care Coordinator | 2120 N Lakewood Dr Ste B, Coeur D Alene, ID 83814-2638 | 2012-11-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104453950 | Shane Robinson | Case Manager/Care Coordinator | 131 W Bridge St, Blackfoot, ID 83221-2704 | 2020-03-23 |
| 1386295517 | Diane Miller | Case Manager/Care Coordinator | 601 N San Juan Way, Boise, ID 83712-6524 | 2019-09-29 |
| 1932631207 | Sarah Louise Price | Case Manager/Care Coordinator | 1018 Briarwood Dr, Nampa, ID 83651-2115 | 2017-03-28 |
| 1184082638 | Sandi Francis | Case Manager/Care Coordinator | 1271 W Quinn Rd, Pocatello, ID 83202-2755 | 2016-01-29 |
| 1093180895 | Melissa Goeckner | Case Manager/Care Coordinator | 233 Gooding St. N, Twin Falls, ID 83301-6179 | 2015-12-04 |
| 1124492863 | Jessica Anne Logan | Case Manager/Care Coordinator | 1522 Michael St, Emmett, ID 83617-9442 | 2015-11-18 |
| 1184016610 | Danica Williams | Case Manager/Care Coordinator | 8644 Mason Lane, Bruneau, ID 89832 | 2015-02-20 |
| 1285997908 | Kimberly Ann Carruthers | Case Manager/Care Coordinator | 1991 S Doe Creek Way, Boise, ID 83709-8518 | 2012-06-18 |
| 1295093789 | Lylena Marie Self | Case Manager/Care Coordinator | 1720 N Westgate Dr Ste 1a, Boise, ID 83704-7164 | 2012-05-02 |
| 1760753578 | Khiale Nora Harvard | Case Manager/Care Coordinator | 811 12th Ave S, #2, Nampa, ID 83651-4656 | 2012-01-25 |
| Find all providers with the same taxonomy | ||||
| City | COEUR D ALENE |
| Zip Code | 83814 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.