Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

AVALON NOEL TAYLOR DERLACKI PRENTISS LPC
NPI 1174196299
Counselor - Mental Health in Boise, ID

Q: What is Avalon Derlacki Prentiss's NPI number?

The NPI number for Avalon Derlacki Prentiss is 1174196299. It was assigned to this individual provider in the NPPES registry on July 19, 2021.

Q: What is Avalon Derlacki Prentiss's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: Is Avalon Derlacki Prentiss enrolled in Medicare?

No. Avalon Derlacki Prentiss has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Active since July 19, 2021Opted out of Medicare · through Jan 1, 2028

1407 N 13TH ST, BOISE, ID 83702(208) 207-8889 Get Directions Write a Review

NPPES record last updated: August 25, 2026. Verified against the NPPES registry weekly; last sync: September 13, 2026.

Record update history: Aug 25, 2026, Nov 19, 2024, Jan 5, 2024 and 2 more (5 updates tracked since 2021).

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About Avalon Noel Taylor Derlacki Prentiss Lpc NPPES

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

AVALON NOEL TAYLOR DERLACKI PRENTISS LPC (NPI 1174196299) is an individual mental health provider in Boise, Idaho, licensed in Idaho (8331165) and active in the NPI registry since July 2021. She has opted out of Medicare through January 1, 2028.

NPPES Registry Identity

NPI1174196299

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameAVALON NOEL TAYLOR DERLACKI PRENTISSCredential: LPC

Location Address1407 N 13TH STBoise, ID 83702-3531

Mailing Address1407 N 13th StBoise, ID 83702-3531

Phone(208) 207-8889

Sole ProprietorYes

Enumeration DateJuly 19, 2021

Last NPPES UpdateAugust 25, 20265 updates tracked since enumeration

NPPES CertifiedAugust 25, 2026

✔ NPI 1174196299 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in ID · 8331165

1407 N 13TH ST, Boise, ID 83702

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Select Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Avalon Noel Taylor Derlacki Prentiss Lpc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2024 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2024

Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 5

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

ROBERTA CROCKETT M.A., LMFT, LCPC

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