1114132693 NPI number — VANESSA RENEE ANSTINE MED., LCPC, NCC, DCC

Table of content: VANESSA RENEE ANSTINE MED., LCPC, NCC, DCC (NPI 1114132693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114132693 NPI number — VANESSA RENEE ANSTINE MED., LCPC, NCC, DCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANSTINE
Provider First Name:
VANESSA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MED., LCPC, NCC, DCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STROUPE
Provider Other First Name:
VANESSA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114132693
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1044 NORTHWEST BLVD
Provider Second Line Business Mailing Address:
SUITE E 118
Provider Business Mailing Address City Name:
COEUR D ALENE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83814-2114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-659-0958
Provider Business Mailing Address Fax Number:
877-777-6965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1044 NORTHWEST BLVD
Provider Second Line Business Practice Location Address:
SUITE E 118
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-659-0958
Provider Business Practice Location Address Fax Number:
877-777-6965
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LCPC-314 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5128563 . This is a "AMERICAN COUNSELING ASSOC" identifier . This identifiers is of the category "OTHER".
  • Identifier: CRC-00014445 . This is a "CERTIFIED REHAB COUNSELOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: NCC-64680 . This is a "NATIONAL CERT. COUNSELOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: DCC 1776 . This is a "DISTANCE CREDENTIALED COUNSELOR - DCC" identifier . This identifiers is of the category "OTHER".
  • Identifier: LCPC-314 . This is a "STATE OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 11834998 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 805716700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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