Per Ordal Eisenman
Individual provider Active NPI Mental Health Counselor · Middlebury, VT
NPI 1104565985 · NPPES record last updated Jul 19, 2022
Key facts
- NPI
- 1104565985
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 0680134620 (VT)
- Practice address
- 67 Catamount Park
Middlebury, VT 05753-1397 - Phone
- (802) 388-6751
- Fax
- (802) 388-8183
- NPI assigned
- Jun 1, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- University of Vermont College of Medicine, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Counseling Service of Addison County Inc
Practice addresses (Care Compare)
89 Main St
Middlebury, VT 05753-1459
Phone (802) 388-6751
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240621001628 | VT | Practitioner - Mental Health Counselor | 0547703365 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0680134620 | VT | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Counseling Service of Addison County, Inc | Current |
Accepting new patients | |
| Per Eisenman, Ms, PLC | Mental Health | Current |
Accepting new patients |
| Counseling Service of Addison County, Inc | Current |
Accepting new patients | |
| Counseling Service of Addison County | Past |
Accepting new patients |
Locations
109 Catamount Park
Middlebury, VT 05753
Phone (802) 388-4021
89 Main St
Middlebury, VT 05753
Phone (802) 388-6751
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 0680134620 | VT | Yes |
Addresses
Primary practice location
67 Catamount Park
Middlebury, VT 05753-1397
Mailing address
89 Main St
Middlebury, VT 05753-1483
Phone (802) 388-6751
Other providers in Middlebury, VT
- Ania Windsong Dziurzynski
- Kylie A Eagan
- Eastview at Middlebury, Inc
- Rebecca Carlsen Edwards
- Scott D Eisele
- Elderly Services, Inc.
- Elizabeth Singe Elliott
- Judith L English
- Roberta Enright
- Clare L. Evancie
All providers in Middlebury, VT · Mental Health Counselor in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.