NPIMap

Organization Active NPI

Ankeny Family Counseling

  • Mental Health Counselor
  • Ankeny, IA
National Provider Identifier
1053804617
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
00918 Issued in IA
Legal business name
ANKENY FAMILY COUNSELING
Practice address
1850 SW Plaza Shops LN Ste D
Ankeny, IA 50023-7168
Phone
(515) 508-1150
Fax
(866) 473-0770
NPI assigned
Jun 8, 2018
Last updated
Oct 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

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

Authorized official

Name
Vicki Jo Ailey-Roberson, LMHCNPI 1790912517
Title
Owner
Phone
(515) 508-1150

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 00918 IA Primary

Addresses

Primary practice location

1850 SW Plaza Shops LN Ste D
Ankeny, IA 50023-7168

Mailing address

1850 SW Plaza Shops LN Ste D
Ankeny, IA 50023-7168
Phone (515) 508-1150

Other identifiers 1

IdentifierTypeStateIssuer
1790912517MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240814004637 IA Part B Supplier - Clinic/Group Practice 6103364666 Receives reassigned benefits from 8 practitioners
Practice locations: Ankeny, IA

National Provider Directory

National Provider Directory

Locations

1850 SW Plaza Shops Ln
Ste D
Ankeny, IA 50023
Phone (515) 228-6596

2301 W 1st St
Ste 4
Ankeny, IA 50023
Phone (515) 508-1150

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634601600000",
    "number": "1053804617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 SW PLAZA SHOPS LN STE D",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500237168",
            "telephone_number": "515-508-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 SW PLAZA SHOPS LN STE D",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500237168",
            "telephone_number": "515-508-1150",
            "fax_number": "866-473-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANKENY FAMILY COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-08",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A",
        "authorized_official_last_name": "AILEY-ROBERSON",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-508-1150",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "00918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790912517",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ankeny, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; 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.