Individual provider Active NPI

Bethany Leigh Nelligan, LMHC, CASAC

  • Mental Health Counselor
  • Hamburg, NY
National Provider Identifier
1164286670
Registry record updated Feb 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
009318-01 Issued in NY
Practice address
3937 Yale Ave
Hamburg, NY 14075-2810
Phone
(716) 512-9195
NPI assigned
Feb 6, 2024
Last updated
Feb 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 009318-01 NY Primary

Addresses

Primary practice location

3937 Yale Ave
Hamburg, NY 14075-2810

Mailing address

3937 Yale Ave
Hamburg, NY 14075-2810
Phone (716) 512-9195

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20241119002539 NY Practitioner - Mental Health Counselor 0648705327 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
009318-01NYMDMental Health Counselor
009318NYMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Mental Health CurrentSince Oct 25, 2024 Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

165 Broadway
Fl 23
New York, NY 10006
Phone (202) 972-4964

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1707177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707177600000",
    "number": "1164286670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3937 YALE AVE",
            "city": "HAMBURG",
            "state": "NY",
            "postal_code": "140752810",
            "telephone_number": "716-512-9195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3937 YALE AVE",
            "city": "HAMBURG",
            "state": "NY",
            "postal_code": "140752810",
            "telephone_number": "716-512-9195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELLIGAN",
        "first_name": "BETHANY",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "LMHC, CASAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-06",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "009318-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamburg, NY

Sources for this page

Verify at the official NPI Registry.