Phoenix Counseling and Wellness, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

PHOENIX COUNSELING AND WELLNESS, LLC

Practice address

35104 Euclid Ave Ste 306
Willoughby, OH 44094-4566

Phone

(440) 571-5009

Fax

(440) 571-4850

NPI assigned

Aug 11, 2020

Organization subpart

No

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

Authorized official

Name

Ms. Jacqueline Nashelle Lockett, MSSA, LSWNPI 1497255343

Title

Clinical Therapist/Owner

Phone

(440) 571-5009

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 1

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

• Jacqueline Nashelle Lockett, LISW

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Willoughby, OH
  • NPI 1497255343

  Clinical

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666828800000",
    "number": "1154932473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35104 EUCLID AVE STE 306",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944566",
            "telephone_number": "440-571-5009",
            "fax_number": "440-571-4850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35104 EUCLID AVE STE 306",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944566",
            "telephone_number": "440-571-5009",
            "fax_number": "440-571-4850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX COUNSELING AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-11",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A",
        "authorized_official_last_name": "LOCKETT",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "NASHELLE",
        "authorized_official_title_or_position": "CLINICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "440-571-5009",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSSA, LSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497255343",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlockett@phoenixcounselingoh.com",
            "affiliation": "N",
            "endpointDescription": "business email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "35104 Euclid Ave Ste 306",
            "city": "Willoughby",
            "state": "OH",
            "country_code": "US",
            "postal_code": "440944566",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlockett@phoenixcounselingoh.com",
            "affiliation": "N",
            "endpointDescription": "business email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "35104 Euclid Ave Ste 306",
            "city": "Willoughby",
            "state": "OH",
            "country_code": "US",
            "postal_code": "440944566",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maria C Petty, NURSE PRACTITIONER
• Jill K. Peysha
• Lydia Pfeifle, LMT
• Phillip W Wallace DDS Inc
• Amanda Ann Phillips, PT
• Tracey L Picard
• Ante Pilekic
• Tomislav Pilekic
• Pink Hearts Inc
• Katarina Plavljanic, CNP

• Mental Health Clinic/Center (Including Community Mental Health Center) in Willoughby, OH
• Providers in Willoughby, OH by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; 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.