MEDICARE: THE THERAPIST EDGE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1568318558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE THERAPIST EDGE PLLC

Provider Business Mailing Address
First Line	:	19743 SUSQUEHANNA WAY
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-8051
Country	:	US
Telephone Number	:	760-705-7257
Fax Number	:	760-705-7257

Provider Business Practice Location Address
First Line	:	19743 SUSQUEHANNA WAY
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-8051
Country	:	US
Telephone Number	:	760-705-7257
Fax Number	:	760-705-7257

Authorized Official
Title or Position	:	OWNER
Name	:	CLARISSA LAUGHLIN
Credential	:	LCSW
Telephone Number	:	760-705-7257

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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