Active NPI
Jessica L Luttrell
- Addiction (Substance Use Disorder) Counselor
- Mansfield, OH
National Provider Identifier
1023505872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CDCA.151810
- Practice address
- 780 Park Ave W
Mansfield, OH 44906-3009 - Phone
- (419) 709-8103
- NPI assigned
- Apr 17, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CDCA.151810 | OH | Primary |
Addresses
Primary practice location
780 Park Ave W
Mansfield, OH 44906-3009
Mailing address
47 Sunset Rd N
Ontario, OH 44906-2273
Phone (484) 354-1614
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CDCA.151810 | OH | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523923200000",
"number": "1023505872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "47 SUNSET RD N",
"city": "ONTARIO",
"state": "OH",
"postal_code": "449062273",
"telephone_number": "484-354-1614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "780 PARK AVE W",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449063009",
"telephone_number": "419-709-8103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTTRELL",
"first_name": "JESSICA",
"middle_name": "L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-17",
"last_updated": "2018-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "CDCA.151810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.