| Lifepath Services Llc | |
|
8675 W Ardene St Boise ID 83709 | |
| (208) 780-3900 | |
| (208) 375-2882 |
| Full Name | Lifepath Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 8675 W Ardene St, Boise, Idaho |
| Authorized Official Name and Position | Tiffaney Giles (DIRECTOR) |
| Authorized Official Contact | 2087803900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifepath Services Llc 8675 W Ardene St Boise ID 83709 Ph: (208) 780-3900 | Lifepath Services Llc 8675 W Ardene St Boise ID 83709 Ph: (208) 780-3900 |
| NPI Number | 1477920270 |
|---|---|
| Provider Enumeration Date | 08/27/2015 |
| Last Update Date | 10/30/2023 |
| Certification Date | 10/30/2023 |
| Medicare PECOS PAC ID | 9638487515 |
|---|---|
| Medicare Enrollment ID | O20150925000838 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477920270 | NPI | - | NPPES |
| 1477920270 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Stephen Zeimantz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922001478 PECOS PAC ID: 7719075399 Enrollment ID: I20071115000105 |
| Provider Name | Aaron L Thomason |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730311564 PECOS PAC ID: 2769521087 Enrollment ID: I20130927000698 |
| Provider Name | Ann Turner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700164621 PECOS PAC ID: 4789819400 Enrollment ID: I20131104001385 |
| Provider Name | Michelle Chin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649645938 PECOS PAC ID: 9133421423 Enrollment ID: I20160104001128 |
| Provider Name | Katie Lynn Harp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316612062 PECOS PAC ID: 6507264660 Enrollment ID: I20211005000862 |
| Provider Name | Matthew R Thorusen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740782523 PECOS PAC ID: 4284091810 Enrollment ID: I20230613000864 |
| Provider Name | Kinsey Elora Nelson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598045585 PECOS PAC ID: 8325481336 Enrollment ID: I20240207000547 |
| Provider Name | Russell Paul Adams |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1164841474 PECOS PAC ID: 6709176944 Enrollment ID: I20240215004130 |
| Provider Name | Jennifer June Weiss |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598288169 PECOS PAC ID: 6709222979 Enrollment ID: I20240311000491 |
| Provider Name | Michael Earnest Callender |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982131314 PECOS PAC ID: 6507202363 Enrollment ID: I20240314003537 |
| Provider Name | Serria Kathleen Sarrazolla |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104559293 PECOS PAC ID: 2668913302 Enrollment ID: I20240920001610 |
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