Clarvida | |
545 N Benjamin Ln Ste 185 Boise ID 83704-9625 | |
(208) 322-1026 | |
(208) 322-1029 |
Full Name | Clarvida |
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Speciality | Community/Behavioral Health |
Location | 545 N Benjamin Ln Ste 185, Boise, Idaho |
Authorized Official Name and Position | Ryan Jones (IDAHO STATE DIRECTOR) |
Authorized Official Contact | 2083221026 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Clarvida 545 N Benjamin Ln Ste 185 Boise ID 83704-9625 Ph: (208) 322-1026 | Clarvida 545 N Benjamin Ln Ste 185 Boise ID 83704-9625 Ph: (208) 322-1026 |
NPI Number | 1326466988 |
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Provider Enumeration Date | 04/01/2014 |
Last Update Date | 06/20/2024 |
Certification Date | 05/31/2024 |
Medicare PECOS PAC ID | 4789808759 |
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Medicare Enrollment ID | O20140612001789 |
Identifier | Type | State | Issuer |
---|---|---|---|
1326466988 | NPI | - | NPPES |
20004720 | Other | ID | MEDICARE PTAN |
Provider Name | Jody A Gray |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1821352329 PECOS PAC ID: 3971758020 Enrollment ID: I20130221000515 |
Provider Name | Sharon L Bennett |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598189821 PECOS PAC ID: 1658594049 Enrollment ID: I20140604000901 |
Provider Name | Shannon Binder |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1710386396 PECOS PAC ID: 4688895527 Enrollment ID: I20141017002390 |
Provider Name | Susan Martinelli |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1366629388 PECOS PAC ID: 9335216068 Enrollment ID: I20150909002371 |
Provider Name | Susan C Brown |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1477837698 PECOS PAC ID: 1254692593 Enrollment ID: I20180228001911 |
Provider Name | Shannon H Moskitis |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1144672635 PECOS PAC ID: 0941610034 Enrollment ID: I20201030001109 |
Provider Name | Stacie S Karlinsey |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1356989909 PECOS PAC ID: 6608250329 Enrollment ID: I20220830002527 |
Provider Name | Samantha J Leavitt |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1881264950 PECOS PAC ID: 2163896564 Enrollment ID: I20230327002129 |
Provider Name | Amanda L Jacobs |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1760946289 PECOS PAC ID: 7810355583 Enrollment ID: I20230628001550 |
Provider Name | Rachael J Anderson |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1437766805 PECOS PAC ID: 7618329335 Enrollment ID: I20240118002280 |
Provider Name | Kara J Hudson |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1427487479 PECOS PAC ID: 6507200110 Enrollment ID: I20240221003685 |
Provider Name | Elisabeth A Pederson |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1578286407 PECOS PAC ID: 9133566649 Enrollment ID: I20240320000758 |
Provider Name | Alex L North |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1841941291 PECOS PAC ID: 6901245828 Enrollment ID: I20240411002529 |
Provider Name | Douglas J Shey |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1821391525 PECOS PAC ID: 5698114338 Enrollment ID: I20240415002371 |
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