=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487263976
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUEPRINT COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2020
-----------------------------------------------------
Last Update Date | 04/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 943 W OVERLAND RD STE 157
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83642-6541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-298-4444
-----------------------------------------------------
Fax | 888-972-8915
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1708 S ROBERT ST
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83705-3160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-398-4444
-----------------------------------------------------
Fax | 888-972-8915
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND LCPC
-----------------------------------------------------
Name | JAMI CLEVENGER
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 208-398-4444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------