Active NPI
Rozi P Wax, LMHC
- Mental Health Counselor
- Mishawaka, IN
National Provider Identifier
1053482653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 39001347A
- Practice address
- 113 Lincoln Way East
Mishawaka, IN 46544-2016 - Phone
- (574) 255-4976
- Fax
- (574) 255-1882
- NPI assigned
- Nov 13, 2006
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 39001347A | IN | Primary |
Addresses
Primary practice location
113 Lincoln Way East
Mishawaka, IN 46544-2016
Mailing address
113 Lincoln Way East
Mishawaka, IN 46544-2016
Phone (574) 255-4976
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7628748 | Other | IN | AETNA |
| 200475040 | Medicaid | IN | |
| 000000341229 | Other | IN | ANTHEM |
| 795208000 | Other | IN | MAGELLAN |
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 |
|---|---|---|---|
| 39001347A | IN | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Bend Mental Health Associates, PC | Past | Accepting new patients | |
| Lincoln Counseling, PC | Counselor | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Mishawaka, IN
- NPI 1740489939
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579824000000",
"number": "1053482653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 LINCOLN WAY EAST",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465442016",
"telephone_number": "574-255-4976",
"fax_number": "574-255-1882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 LINCOLN WAY EAST",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465442016",
"telephone_number": "574-255-4976",
"fax_number": "574-255-1882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAX",
"first_name": "ROZI",
"middle_name": "P",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-13",
"last_updated": "2020-01-24",
"certification_date": "2020-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "39001347A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7628748",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200475040",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000341229",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "795208000",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.