NPIMap

Organization Active NPI

Innovative Therapeutic Services, LLC

  • Mental Health Counselor
  • Laurel, MD
National Provider Identifier
1003147505
Registry record updated Mar 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LC3403 Issued in MD
Legal business name
INNOVATIVE THERAPEUTIC SERVICES, LLC
Practice address
14440 Cherry Lane CT
Suite 208
Laurel, MD 20707-4946
Phone
(301) 604-1458
NPI assigned
Jan 22, 2010
Last updated
Mar 9, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Misty Cromartie, LCPCNPI 1396061487
Title
Ceo
Phone
(301) 455-7872

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LC1655 MD
Mental Health Counselor 101YM0800X LC3403 MD Primary
Clinical Social Worker 1041C0700X 15169 MD

Addresses

Primary practice location

14440 Cherry Lane CT
Suite 208
Laurel, MD 20707-4946

Mailing address

14440 Cherry Lane CT
Suite 208
Laurel, MD 20707-4946
Phone (301) 604-1458

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140218000837 MD Part B Supplier - Clinic/Group Practice 9436388345 Receives reassigned benefits from 1 practitioner
Practice locations: Laurel, MD

National Provider Directory

National Provider Directory

Locations

20 W Washington St
Ste 503
Hagerstown, MD 21740
Phone (301) 393-3949

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331251200000",
    "number": "1003147505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14440 CHERRY LANE CT",
            "address_2": "SUITE 208",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074946",
            "telephone_number": "301-604-1458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14440 CHERRY LANE CT",
            "address_2": "SUITE 208",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207074946",
            "telephone_number": "301-604-1458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE THERAPEUTIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-22",
        "last_updated": "2012-03-09",
        "status": "A",
        "authorized_official_last_name": "CROMARTIE",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-455-7872",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LC1655",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LC3403",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "15169",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.