Active NPI
Ivory Headspeth Mitchell, LPN
- Case Manager/Care Coordinator
- Hammond, LA
National Provider Identifier
1104311257
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 906 C M Fagan Dr BLDG a
Hammond, LA 70403-6056 - Phone
- (985) 956-7370
- Fax
- (985) 956-7371
- NPI assigned
- Jun 29, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
906 C M Fagan Dr BLDG a
Hammond, LA 70403-6056
Mailing address
906 C M Fagan Dr BLDG a
Hammond, LA 70403-6056
Phone (985) 956-7370
Other names 1
- Ivory Headspeth
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Choice Counseling Service, LLC | Past | Accepting new patients |
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Springfield, LA
- NPI 1750808267
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530230400000",
"number": "1104311257",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "906 C M FAGAN DR BLDG A",
"city": "HAMMOND",
"state": "LA",
"postal_code": "704036056",
"telephone_number": "985-956-7370",
"fax_number": "985-956-7371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "906 C M FAGAN DR BLDG A",
"city": "HAMMOND",
"state": "LA",
"postal_code": "704036056",
"telephone_number": "985-956-7370",
"fax_number": "985-956-7371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "IVORY",
"middle_name": "HEADSPETH",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-29",
"last_updated": "2018-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "IVORY",
"last_name": "HEADSPETH",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Hammond, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.