Provider Demographics
NPI:1114132693
Name:ANSTINE, VANESSA RENEE (MED, LCPC, NCC, DCC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:RENEE
Last Name:ANSTINE
Suffix:
Gender:F
Credentials:MED, LCPC, NCC, DCC
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:RENEE
Other - Last Name:STROUPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1044 NORTHWEST BLVD
Mailing Address - Street 2:SUITE E 118
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2114
Mailing Address - Country:US
Mailing Address - Phone:208-659-0958
Mailing Address - Fax:877-777-6965
Practice Address - Street 1:1044 NORTHWEST BLVD
Practice Address - Street 2:SUITE E 118
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2114
Practice Address - Country:US
Practice Address - Phone:208-659-0958
Practice Address - Fax:877-777-6965
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-314101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
5128563OtherAMERICAN COUNSELING ASSOC
CRC-00014445OtherCERTIFIED REHAB COUNSELOR
NCC-64680OtherNATIONAL CERT. COUNSELOR
DCC 1776OtherDISTANCE CREDENTIALED COUNSELOR - DCC
IDLCPC-314OtherSTATE OF IDAHO
11834998OtherCAQH
ID805716700Medicaid