Active NPI
Jason Cunningham, LPCC, LICDC
- Mental Health Counselor
- Lorain, OH
National Provider Identifier
1114387685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- E.2303364
- Practice address
- 2115 W Park Dr
Lorain, OH 44053-1138 - Phone
- (440) 989-4987
- Fax
- (440) 282-4779
- NPI assigned
- Feb 26, 2016
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | C.2003043 | OH | |
| Mental Health Counselor | 101YM0800X | |||
| Mental Health Counselor | 101YM0800X | E.2303364 | OH | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1312443 | OH | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LICDC.162045 | OH |
Addresses
Primary practice location
2115 W Park Dr
Lorain, OH 44053-1138
Mailing address
2115 W Park Dr
Lorain, OH 44053-1138
Phone (440) 989-4900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0383469 | Medicaid | OH |
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 |
|---|---|---|---|
| 1312443 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| LICDC.162045 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| C.2003043 | OH | MD | Mental Health Counselor |
| E.2303364 | OH | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682985600000",
"number": "1114387685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2115 W PARK DR",
"city": "LORAIN",
"state": "OH",
"postal_code": "440531138",
"telephone_number": "440-989-4900",
"fax_number": "440-282-4779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2115 W PARK DR",
"city": "LORAIN",
"state": "OH",
"postal_code": "440531138",
"telephone_number": "440-989-4987",
"fax_number": "440-282-4779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUNNINGHAM",
"first_name": "JASON",
"credential": "LPCC, LICDC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-02-26",
"last_updated": "2023-05-02",
"certification_date": "2023-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OH",
"license": "C.2003043",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OH",
"license": "E.2303364",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "1312443",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "LICDC.162045",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0383469",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lorain, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.