Individual provider Active NPI

Amanda Mills Tallman

  • Mental Health Counselor
  • Fort Wayne, IN
National Provider Identifier
1083320717
Registry record updated Mar 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
39005398A Issued in IN
Practice address
909 E State Blvd
Fort Wayne, IN 46805-3404
Phone
(260) 481-2700
NPI assigned
Jan 26, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2025

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 39005398A IN Primary

Addresses

Primary practice location

909 E State Blvd
Fort Wayne, IN 46805-3404

Mailing address

909 E State Blvd
Fort Wayne, IN 46805-3404

Other names 1

  • Mandy Mills Professional name

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
I20250514003549 IN Practitioner - Mental Health Counselor 8820516735 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Four County Comprehensive Mental Health Center IncGroup PAC ID 2163334277, 42 clinicians

Practice addresses (Care Compare)

1000 N Broadway
Peru, IN 46970-1070
Phone (574) 722-5151

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Four County Comprehensive Mental Health Center, Inc CurrentSince May 6, 2025 Accepting new patients
Four County Comprehensive Mental Health Center Inc CurrentSince May 6, 2025 Accepting new patients
Hand in Hand Comprehensive Therapy Specialists Inc PastSince Apr 1, 2023 Accepting new patients

Locations

3002 E Wabash St
Frankfort, IN 46041

2796 N Apperson Way
Kokomo, IN 46901

1948 W Boulevard
Kokomo, IN 46902
Phone (765) 236-1290

421 12th St
Logansport, IN 46947
Phone (574) 722-7407

800 Fulton St
Logansport, IN 46947
Phone (574) 205-2600

1015 Michigan Ave
Logansport, IN 46947

1 Landis Ln
Logansport, IN 46947

1000 N Broadway
Peru, IN 46970
Phone (765) 472-5335

2355 S Business 31
Peru, IN 46970

1 Zebra Ln
Rochester, IN 46975
Phone (574) 223-2159

401 E 8th St
Rochester, IN 46975
Phone (574) 223-8565

417 S Chicago St
Royal Center, IN 46978

619 S Main St
Tipton, IN 46072

1060 S Main St
Tipton, IN 46072
Phone (765) 675-1111

2418 Curtis Dr
Winamac, IN 46996
Phone (219) 946-7710

Organizations & group practices 3

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": "1674691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742601600000",
    "number": "1083320717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468053404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468053404",
            "telephone_number": "260-481-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLS TALLMAN",
        "first_name": "AMANDA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-26",
        "last_updated": "2025-03-22",
        "certification_date": "2025-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39005398A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANDY",
            "last_name": "MILLS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.