1. Home
  2. Directory
  3. Idaho
  4. Boise
  5. Counselor
  6. NPI Profile

RANDY WILD LCPC
NPI 1295939080
Counselor - Mental Health in Boise, ID

Active since June 13, 2007Opted out of Medicare · through Feb 13, 2027
3152 S BOWN WAY STE 103, BOISE, ID 83706(541) 550-7940(541) 550-7941 Get Directions Write a Review

NPPES record last updated: February 14, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Randy Wild Lcpc NPPES

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

RANDY WILD LCPC (NPI 1295939080) is an individual mental health provider in Boise, Idaho, licensed in Oregon (C1740) and active in the NPI registry since June 2007. He has opted out of Medicare through February 13, 2027.

NPPES Registry Identity

NPI1295939080
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameRANDY WILDCredential: LCPC
Location Address3152 S BOWN WAY STE 103Boise, ID 83706-5456
Mailing Address3152 S Bown Way Ste 103Boise, ID 83706-5456 · (541) 550-7940 · Fax (541) 550-7941
Phone(541) 550-7940
Fax(541) 550-7941
Sole ProprietorYes
Enumeration DateJune 13, 2007
Last NPPES UpdateFebruary 14, 2024
NPPES CertifiedFebruary 14, 2024
✔ NPI 1295939080 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 OR · C1740
3152 S BOWN WAY STE 103, Boise, ID 83706
Open in Google Maps ↗

Accepted Insurance

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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Randy Wild Lcpc 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 February 13, 2025 through February 13, 2027.

Opt-Out Effective DateFebruary 13, 2025
Opt-Out In Effect ThroughFebruary 13, 2027Opt-out affidavits renew automatically every two years unless cancelled

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 Randy Wild's NPI number?

The NPI number for Randy Wild is 1295939080. It was assigned to this individual provider in the NPPES registry on June 13, 2007.

Where is Randy Wild located?

Randy Wild practices at 3152 S Bown Way Ste 103, Boise, ID 83706. The listed phone number is (541) 550-7940.

What is Randy Wild's specialty?

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

Is Randy Wild enrolled in Medicare?

No. Randy Wild has opted out of Medicare through February 13, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Randy Wild accept?

Health plans from BridgeSpan Health Company, Moda Health Plan, Inc., PacificSource Health Plans, Providence Health Plan and Regence BlueCross BlueShield of Oregon list Randy Wild 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 Randy Wild was last updated on February 14, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.