NPIMap

Organization Active NPI

Heritage Christian Counseling of Shelby

  • Clinical Social Worker
  • Shelby, OH
National Provider Identifier
1114700622
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
HERITAGE CHRISTIAN COUNSELING OF SHELBY
Practice address
153 Mansfield Ave Ste B
Shelby, OH 44875-1832
Phone
(567) 844-0036
NPI assigned
Aug 17, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeaneen PerryNPI 1326398736
Title
Owner
Phone
(567) 844-0036

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

153 Mansfield Ave Ste B
Shelby, OH 44875-1832

Mailing address

153 Mansfield Ave Ste B
Shelby, OH 44875-1832

Other practice location 1

1066 Lexington Ave
Mansfield, OH 44907-2250
Phone (419) 709-8447

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240322004197 OH Part B Supplier - Clinic/Group Practice 6406293687 Receives reassigned benefits from 7 practitioners
Practice locations: Shelby, OH; Mansfield, OH

National Provider Directory

National Provider Directory

Locations

153 Mansfield Ave
#B
Shelby, OH 44875
Phone (567) 844-0036

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1692230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1114700622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 MANSFIELD AVE STE B",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448751832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 MANSFIELD AVE STE B",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448751832",
            "telephone_number": "567-844-0036"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1066 Lexington Ave",
            "address_purpose": "LOCATION",
            "city": "Mansfield",
            "state": "OH",
            "postal_code": "449072250",
            "country_code": "US",
            "telephone_number": "419-709-8447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HERITAGE CHRISTIAN COUNSELING OF SHELBY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-17",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "JEANEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "567-844-0036"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.