Provider Demographics
NPI:1487263976
Name:BLUEPRINT COUNSELING
Entity type:Organization
Organization Name:BLUEPRINT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND LCPC
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVENGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-398-4444
Mailing Address - Street 1:1708 S ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-3160
Mailing Address - Country:US
Mailing Address - Phone:208-398-4444
Mailing Address - Fax:888-972-8915
Practice Address - Street 1:943 W OVERLAND RD STE 157
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6541
Practice Address - Country:US
Practice Address - Phone:208-298-4444
Practice Address - Fax:888-972-8915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1477920270Medicaid