1538291554 NPI number — WEEKS AND VIETRI COUNSELING & COMMUNITY SERVICES. PS

Table of content: (NPI 1538291554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538291554 NPI number — WEEKS AND VIETRI COUNSELING & COMMUNITY SERVICES. PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEEKS AND VIETRI COUNSELING & COMMUNITY SERVICES. PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538291554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
818 S WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOSCOW
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83843-3049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-882-8514
Provider Business Mailing Address Fax Number:
208-882-2784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
818 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOSCOW
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83843-3049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-882-8514
Provider Business Practice Location Address Fax Number:
208-882-2784
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEEKS
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-882-8514

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  217 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TA0400X , with the licence number: 202119 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8053401 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 820495613AA . This is a "UNIFORM INSURANCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: N6278 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 8040032 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2V29936 . This is a "BUSINESS PSYCHOLOGY ASSOC" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 8041410 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000010016330 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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