| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 07/01/2020 |
| Last Update Date | 10/22/2021 |
| Certification Date | 10/22/2021 |
| Medicare PECOS PAC ID | 5890106918 |
|---|---|
| Medicare Enrollment ID | O20201123000000 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376160820 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Chrystal Marie Anardi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477877579 PECOS PAC ID: 4385907013 Enrollment ID: I20200908000147 |
| Provider Name | Lori Rohde |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053860676 PECOS PAC ID: 9931596822 Enrollment ID: I20220422002346 |
| Provider Name | Heather M Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346758042 PECOS PAC ID: 1759778657 Enrollment ID: I20220422002419 |
| Provider Name | Lisa A Carothers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104451970 PECOS PAC ID: 5698140358 Enrollment ID: I20230411001177 |
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