Individual provider Active NPI

Maryellen Weigand, LMFT

  • Mental Health Counselor
  • Fort Wayne, IN
National Provider Identifier
1073256095
Registry record updated Apr 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
35002212A Issued in IN
Practice address
6157 Stoney Creek Dr
Fort Wayne, IN 46825-4409
Phone
(260) 570-4515
NPI assigned
Apr 18, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 35002212A IN Primary

Addresses

Primary practice location

6157 Stoney Creek Dr
Fort Wayne, IN 46825-4409

Mailing address

6157 Stoney Creek Dr
Fort Wayne, IN 46825-4409
Phone (260) 570-4515

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240202001836 IN Practitioner - Marriage and Family Therapist 6901259282 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
RDR Devine LLCGroup PAC ID 9931515889, 11 clinicians

Practice addresses (Care Compare)

6157 Stoney Creek Dr
Fort Wayne, IN 46825-4409
Phone (260) 570-4518

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
RDR Devine, LLC Mental Health CurrentSince Jan 5, 2024 Accepting new patients

Locations

6157 Stoney Creek Dr
Fort Wayne, IN 46825
Phone (260) 570-4515

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1650240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650240000000",
    "number": "1073256095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6157 STONEY CREEK DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468254409",
            "telephone_number": "260-570-4515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6157 STONEY CREEK DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468254409",
            "telephone_number": "260-570-4515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIGAND",
        "first_name": "MARYELLEN",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-18",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "35002212A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.