NPIMap

Organization Active NPI

Moundbuilders Guidance Center, Inc

  • Counselor
  • Newark, OH
National Provider Identifier
1043489503
Registry record updated Feb 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
MOUNDBUILDERS GUIDANCE CENTER, INC
Practice address
65 Messimer Dr
Newark, OH 43055-1874
Phone
(740) 522-8477
NPI assigned
Feb 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2008

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

Authorized official

Name
Laura Edelblute
Title
Chief Operating Officer
Phone
(740) 788-0244

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X Primary

Addresses

Primary practice location

65 Messimer Dr
Newark, OH 43055-1874

Mailing address

65 Messimer Dr
Newark, OH 43055-1874
Phone (740) 522-8477

Other identifiers 1

IdentifierTypeStateIssuer
2485734MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Yoon Hoon Kim MD6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1204156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204156800000",
    "number": "1043489503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 MESSIMER DR",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551874",
            "telephone_number": "740-522-8477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 MESSIMER DR",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551874",
            "telephone_number": "740-522-8477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNDBUILDERS GUIDANCE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-28",
        "last_updated": "2008-02-28",
        "status": "A",
        "authorized_official_last_name": "EDELBLUTE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "740-788-0244"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2485734",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.