Individual provider Active NPI

Sarah Antes, LPC

  • Professional Counselor
  • Canton, OH
National Provider Identifier
1124667878
Registry record updated Oct 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
C.2204060 Issued in OH
Practice address
4522 Fulton Dr NW
Canton, OH 44718-2332
Phone
(330) 915-2907
Fax
(330) 915-2958
NPI assigned
Dec 29, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X C.2204060 OH
Professional Counselor 101YP2500X C.2204060 OH Primary

Addresses

Primary practice location

4522 Fulton Dr NW
Canton, OH 44718-2332

Mailing address

4522 Fulton Dr NW
Canton, OH 44718-2332
Phone (330) 915-2907

Other practice location 1

4200 Munson St NW Ste A
Canton, OH 44718-2981
Phone (330) 915-2907

Other identifiers 1

IdentifierTypeStateIssuer
0386245MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260508001267 OH Practitioner - Mental Health Counselor 8022586981 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Portage Path Community Mental Health CenterGroup PAC ID 5597663344, 46 clinicians

Practice addresses (Care Compare)

340 S Broadway St
Akron, OH 44308-1529
Phone (330) 253-3100

792 Graham Rd
Cuyahoga Falls, OH 44221-1000
Phone (330) 928-2324

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C.2204060OHMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Wellness Grove LLC Mental Health CurrentSince Jul 21, 2024 Accepting new patients
Wellness Grove, LLC Counselor CurrentSince Jun 4, 2023 Accepting new patients

Locations

4200 Munson St NW
Ste A
Canton, OH 44718
Phone (330) 915-2907

4522 Fulton Dr NW
Canton, OH 44718
Phone (330) 915-2907

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1577577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729900800000",
    "number": "1124667878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4522 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182332",
            "telephone_number": "330-915-2907",
            "fax_number": "330-915-2958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4522 FULTON DR NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182332",
            "telephone_number": "330-915-2907",
            "fax_number": "330-915-2958"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4200 Munson St NW Ste A",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "447182981",
            "country_code": "US",
            "telephone_number": "330-915-2907",
            "fax_number": "330-915-2958",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANTES",
        "first_name": "SARAH",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-29",
        "last_updated": "2024-10-26",
        "certification_date": "2024-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "C.2204060",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "C.2204060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0386245",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.