Mind Matters Llc | |
1875 N Lakewood Dr Ste 101 Coeur D Alene ID 83814-4928 | |
(208) 719-9110 | |
Not Available |
Full Name | Mind Matters Llc |
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Speciality | Clinic/Center |
Location | 1875 N Lakewood Dr Ste 101, Coeur D Alene, Idaho |
Authorized Official Name and Position | James Smidt (OWNER) |
Authorized Official Contact | 8556218250 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mind Matters Llc 1875 N Lakewood Dr Ste 101 Coeur D Alene ID 83814-4928 Ph: (208) 719-9110 | Mind Matters Llc 1875 N Lakewood Dr Ste 101 Coeur D Alene ID 83814-4928 Ph: (208) 719-9110 |
NPI Number | 1376160820 |
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Provider Enumeration Date | 07/01/2020 |
Last Update Date | 10/22/2021 |
Certification Date | 10/22/2021 |
Medicare PECOS PAC ID | 5890106918 |
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Medicare Enrollment ID | O20201123000000 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376160820 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Provider Name | Chrystal Marie Anardi |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1477877579 PECOS PAC ID: 4385907013 Enrollment ID: I20200908000147 |
Provider Name | Lori Rohde |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1053860676 PECOS PAC ID: 9931596822 Enrollment ID: I20220422002346 |
Provider Name | Heather M Johnson |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1346758042 PECOS PAC ID: 1759778657 Enrollment ID: I20220422002419 |
Provider Name | Lisa A Carothers |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1104451970 PECOS PAC ID: 5698140358 Enrollment ID: I20230411001177 |
Provider Name | Gary A Mcluskie |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1811138142 PECOS PAC ID: 7315385069 Enrollment ID: I20240401002543 |
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