JEDIDIAH DYKSTRA (NPI# 1972043966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972043966 |
| Entity Type | Individual |
| Full Name | JEDIDIAH DYKSTRA |
| Practice Address |
1140 American Legion Blvd Mountain Home ID 83647-2821 |
| Mailing Address |
16899 N Pamelas Loop Apt 101 Nampa ID 83651-6448 |
| Practice Telephone | 2085805431 |
| Mailing Telephone | 7179262441 |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2017-02-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | Behavioral Health & Social Service Providers |
| Street Address |
1140 AMERICAN LEGION BLVD |
| City | MOUNTAIN HOME |
| State | ID |
| Zip Code | 83647-2821 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528684370 | The Unruly Tongue Myofunctional Therapy LLC | Specialist | 1125 Nw Bluegrass Cir, Mountain Home, ID 83647 | 2020-06-17 |
| 1740767284 | Kelly Loy | Counselor | 210 North 3rd East, Mountain Home, ID 83647 | 2018-07-27 |
| 1891247912 | Daelene Sueann Tibbitts | Physical Therapy Assistant | 1665 E 5th N, Mountain Home, ID 83647 | 2016-10-25 |
| 1689065765 | Emma Orthel | Counselor | 2240 American Legion Blvd, Mountain Home, ID 83647 | 2015-02-11 |
| 1073692166 | Krzysztof Hendryk Ziola | Internal Medicine | 2280 American Legion Blvd., Mountain Home, ID 83647 | 2006-11-02 |
| 1952482440 | Michael Peter Koelsch | Internal Medicine | 805 North 6th East, Mountain Home, ID 83647 | 2006-10-18 |
| 1124113709 | Talmage W Delange | Counselor | 235 North 3rd East, Mountain Home, ID 83647 | 2006-10-03 |
| 1225044019 | Scott W Sessions | Physical Therapist | 245 N. 3rd, Mountain Home, ID 83647 | 2006-07-31 |
| 1750370730 | Kyle J Kenison | Optometrist | 855 West 6th South, Mountain Home, ID 83647 | 2005-10-21 |
| 1285628156 | Bruce Joseph Siedlecki | Obstetrics & Gynecology | Mtn.home Aif Force Base, Mdos, Mtn. Home, ID 83647 | 2005-09-07 |
| Find all providers in zip 83647 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295801512 | Susan Elaine | Marriage & Family Therapist | Lake Dr., Building 52, Mountain Home, TN 37684 | 2006-11-28 |
| 1033280391 | Deanna Kay Howarth-reynolds | Marriage & Family Therapist | 15 E 5th St, Mountain Home, AR 72653-3809 | 2006-11-10 |
| 1184702490 | Teresa K Fletcher | Marriage & Family Therapist | Building 52 Lake Dr, Mountain Home, TN 37684 | 2006-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467070193 | Lana Elizabeth Bronn | Marriage & Family Therapist | 89 N Main St Ste 204, Driggs, ID 83422-5164 | 2020-07-09 |
| 1831725902 | Steven Michael Moroney | Marriage & Family Therapist | 24338 N Mckenzie Dr, Rathdrum, ID 83858-7390 | 2020-03-20 |
| 1285268102 | Sandra Marie Gunn | Marriage & Family Therapist | 2426 N Merritt Creek Loop Ste E, Coeur D Alene, ID 83814-4961 | 2020-02-29 |
| 1790322451 | Karen Casperson | Marriage & Family Therapist | 1018 Atelier Condo Dr., Sun Valley, ID 83353 | 2019-12-02 |
| 1629613823 | Counseling Solutions Center LLC | Marriage & Family Therapist | 2618 East Snocreek, Eagle, ID 83616 | 2019-11-12 |
| 1528602828 | Damaris Ellen Conrad | Marriage & Family Therapist | 205 S Lancaster Dr, Nampa, ID 83686-8077 | 2019-10-30 |
| 1063064111 | Stacy Annette Brittain | Marriage & Family Therapist | 501 E Indiana Ave, Coeur D Alene, ID 83814-2909 | 2019-07-09 |
| 1326510454 | Timothy Young | Marriage & Family Therapist | 211 E Coeur D Alene Ave, Coeur D Alene, ID 83814-4926 | 2018-12-31 |
| 1851819486 | Laura M. Brotherson | Marriage & Family Therapist | Cherry Lane Counseling Center 403 W. Cherry Lane, Meridian, ID 83642 | 2017-09-04 |
| 1699228577 | Relationship Solutions LLC | Marriage & Family Therapist | 1714 N Quail Run Blvd, Post Falls, ID 83854-6024 | 2016-07-27 |
| Find all providers with the same taxonomy | ||||
| City | MOUNTAIN HOME |
| Zip Code | 83647 |
Please comment or provide details below to improve the information on JEDIDIAH DYKSTRA.
| 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.