Active NPI
Michael Southers
- Professional Counselor
- Frederick, MD
National Provider Identifier
1114338282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LC7423
- Practice address
- 100 N Court St
Suite 203
Frederick, MD 21701-5416 - Phone
- (240) 409-4596
- NPI assigned
- May 12, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LGP5510 | MD | |
| Professional Counselor | 101YP2500X | LC7423 | MD | Primary |
Addresses
Primary practice location
100 N Court St
Suite 203
Frederick, MD 21701-5416
Mailing address
100 N Court St
Suite 203
Frederick, MD 21701-5416
Phone (240) 409-4596
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LGP5510 | MD | MD | Mental Health Counselor |
| LC7423 | MD | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479254400000",
"number": "1114338282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N COURT ST",
"address_2": "SUITE 203",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217015416",
"telephone_number": "240-409-4596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N COURT ST",
"address_2": "SUITE 203",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217015416",
"telephone_number": "240-409-4596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHERS",
"first_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-05-12",
"last_updated": "2016-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MD",
"license": "LGP5510",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MD",
"license": "LC7423",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frederick, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.