Individual provider Active NPI

Susan Boyd Dovenmuehle, M.S., L.M.H.C.

  • Mental Health Counselor
  • Bloomington, IN
National Provider Identifier
1083761902
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
39000018A Issued in IN
Practice address
205 N College Ave Ste 210B
Bloomington, IN 47404-3955
Phone
(812) 332-3750
Fax
(812) 332-0828
NPI assigned
Jan 4, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 39000018A IN Primary

Addresses

Primary practice location

205 N College Ave Ste 210B
Bloomington, IN 47404-3955

Mailing address

205 N College Ave Ste 210B
Bloomington, IN 47404-3955
Phone (812) 332-3750

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
39000018AINMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083761902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 N COLLEGE AVE STE 210B",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474043955",
            "telephone_number": "812-332-3750",
            "fax_number": "812-332-0828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N COLLEGE AVE STE 210B",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474043955",
            "telephone_number": "812-332-3750",
            "fax_number": "812-332-0828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOVENMUEHLE",
        "first_name": "SUSAN",
        "middle_name": "BOYD",
        "name_prefix": "Ms.",
        "credential": "M.S., L.M.H.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39000018A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.