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KELSEY LYNNE BLAZICEVICH LPC
NPI 1174149215
Counselor in Caldwell, ID

Active since June 24, 2020PECOS Enrolled
923 GRANT ST, CALDWELL, ID 83605(208) 585-3375(208) 585-6152 Get Directions Write a Review

NPPES record last updated: June 24, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Kelsey Lynne Blazicevich Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELSEY LYNNE BLAZICEVICH LPC (NPI 1174149215) is an individual counselor in Caldwell, Idaho and active in the NPI registry since June 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1174149215
Entity TypeIndividualFemale
Primary Taxonomy101Y00000X
Provider Legal NameKELSEY LYNNE BLAZICEVICHCredential: LPC
Location Address923 GRANT STCaldwell, ID 83605-4137
Mailing Address923 Grant StCaldwell, ID 83605-4137 · (208) 585-3375 · Fax (208) 585-6152
Phone(208) 585-3375
Fax(208) 585-6152
Sole ProprietorYes
Medical School CMSOtherGraduated 2020
Enumeration DateJune 24, 2020
NPPES CertifiedJune 24, 2020
✔ NPI 1174149215 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
923 GRANT ST, Caldwell, ID 83605
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., PacificSource Health Plans, Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelsey Lynne Blazicevich Lpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1052892601
PECOS Enrollment IDI20260223001401
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kelsey Blazicevich reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Cornerstone Family Therapy LLC
21 mi
Mental Health
2995 N COLE RD STE 225
Boise, ID 83704
  • Reassigned Medicare billing, Idaho enrollment
  • 4 clinicians in this Medicare group
NPI 1255052965 (208) 614-0588

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BLANCA AMERICA VALADEZ
Counselor (Mental Health)
923 GRANT ST
CALDWELL, ID 83605
Canyon County (208) 585-3375
BENNETT CHIROPRACTIC CTR PA
Chiropractor
923 GRANT ST
CALDWELL, ID 83605
Canyon County (208) 454-9000
MRS. SAUSHA NICHOLE HYATT LCSW
Social Worker (Clinical)
923 GRANT ST
CALDWELL, ID 83605
Canyon County (208) 585-3375
LINDA RAMIREZ LCSW
Social Worker (Clinical)
923 GRANT ST
CALDWELL, ID 83605
Canyon County (208) 585-3375
CIARA JOANN ANDERSON LMSW
Social Worker
923 GRANT ST
CALDWELL, ID 83605
Canyon County (208) 585-3375
AFTON CAMPBELL SR LMSW
Counselor (Mental Health)
923 GRANT ST
CALDWELL, ID 83605
Canyon County (208) 585-3375
DR. KATHY R BENNETT D.C.
Chiropractor
923 GRANT ST
CALDWELL, ID 83605
Canyon County (208) 454-9000
MAYA JENAE DIAS MSW
Social Worker
923 GRANT ST
CALDWELL, ID 83605
Canyon County (208) 585-3375

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelsey Blazicevich's NPI number?

The NPI number for Kelsey Blazicevich is 1174149215. It was assigned to this individual provider in the NPPES registry on June 24, 2020.

Where is Kelsey Blazicevich located?

Kelsey Blazicevich practices at 923 Grant St, Caldwell, ID 83605. The listed phone number is (208) 585-3375.

What is Kelsey Blazicevich's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

Is Kelsey Blazicevich enrolled in Medicare?

Yes. Kelsey Blazicevich is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kelsey Blazicevich's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelsey Blazicevich reassigns Medicare benefits to Cornerstone Family Therapy LLC (Boise, ID). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelsey Blazicevich's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kelsey Blazicevich accept?

Health plans from Moda Health Plan, Inc., PacificSource Health Plans and Providence Health Plan list Kelsey Blazicevich as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kelsey Blazicevich was last updated on June 24, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.