Individual provider Active NPI

Elizabeth M Fannin

  • Addiction (Substance Use Disorder) Counselor
  • Waverly, OH
National Provider Identifier
1144729468
Registry record updated Feb 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
165910 Issued in OH
Practice address
14574 US Highway 23
Waverly, OH 45690-9373
Phone
(740) 912-9126
NPI assigned
Feb 2, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 165910 OH Primary

Addresses

Primary practice location

14574 US Highway 23
Waverly, OH 45690-9373

Mailing address

14574 US Highway 23
Waverly, OH 45690-9373
Phone (740) 912-9126

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

LicenseStateTypeSpecialty
165910OHMDHome Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Pike County Recovery Council Inc Past Accepting new patients

Organizations & group practices 1

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": "1517529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517529600000",
    "number": "1144729468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14574 US HIGHWAY 23",
            "city": "WAVERLY",
            "state": "OH",
            "postal_code": "456909373",
            "telephone_number": "740-912-9126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14574 US HIGHWAY 23",
            "city": "WAVERLY",
            "state": "OH",
            "postal_code": "456909373",
            "telephone_number": "740-912-9126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNIN",
        "first_name": "ELIZABETH",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-02",
        "last_updated": "2018-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "165910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waverly, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.