Active NPI
Benjamin Kackley
- Mental Health Counselor
- Detroit, MI
National Provider Identifier
1013339225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6401013356
- Practice address
- 24424 W McNichols Rd
Detroit, MI 48219-3653 - Phone
- (313) 255-0900
- NPI assigned
- Jan 8, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6401013356 | MI | Primary |
Addresses
Primary practice location
24424 W McNichols Rd
Detroit, MI 48219-3653
Mailing address
24424 W McNichols Rd
Detroit, MI 48219-3653
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401013356 | MI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389139200000",
"number": "1013339225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24424 W MCNICHOLS RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482193653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24424 W MCNICHOLS RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482193653",
"telephone_number": "313-255-0900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KACKLEY",
"first_name": "BENJAMIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-01-08",
"last_updated": "2014-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MI",
"license": "6401013356",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.