| 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 |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
| 101YP2500X | Counselor - Professional | () | Secondary |
| Provider Name | Lisa a Carothers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104451970 PECOS PAC ID: 5698140358 Enrollment ID: I20230411001177 |
| Provider Name | Vincent Marchese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831847383 PECOS PAC ID: 9436507563 Enrollment ID: I20231129002054 |
| Provider Name | Gary a Mcluskie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811138142 PECOS PAC ID: 7315385069 Enrollment ID: I20240401002543 |
| Provider Name | Elaine Hart |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396489118 PECOS PAC ID: 0941648034 Enrollment ID: I20240409002485 |
| Provider Name | Ryan Ettner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356005367 PECOS PAC ID: 9931693843 Enrollment ID: I20251209001827 |
| Provider Name | Jason a Adams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306274055 PECOS PAC ID: 4880188655 Enrollment ID: I20251209003461 |
| Provider Name | Montanna Clendening |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225998677 PECOS PAC ID: 4981199858 Enrollment ID: I20251218000196 |
| Provider Name | Katrina Campbell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760377717 PECOS PAC ID: 6507345030 Enrollment ID: I20260205001441 |
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