Individual provider Active NPI

India R Mooney, MA, LPC

  • Mental Health Counselor
  • Warren, MI
National Provider Identifier
1184272791
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
6401223867 Issued in MI
Practice address
12200 E 13 Mile Rd
Warren, MI 48093-3093
Phone
(313) 255-8250
NPI assigned
Aug 27, 2019
Last updated
Jan 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 6401019217 MI
Mental Health Counselor 101YM0800X 6401019217 MI
Mental Health Counselor 101YM0800X 6401223867 MI Primary
Professional Counselor 101YP2500X 6401019217 MI
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

12200 E 13 Mile Rd
Warren, MI 48093-3093

Mailing address

4410 W 13 Mile Rd
Royal Oak, MI 48073-6515
Phone (313) 255-8267

Other identifiers 1

IdentifierTypeStateIssuer
6344MedicaidMI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address India_Mooney@judsoncenter.org
Direct Messaging Address India_Mooney@judsoncenter.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20240409000581 MI Practitioner - Mental Health Counselor 9638517766 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
6401019217MIMDCounselor
6401223867MIMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Judson Center, Inc. CurrentSince Feb 18, 2024 Accepting new patients
Judson Center, Inc. CurrentSince Feb 18, 2024 Accepting new patients
County of Macomb CurrentSince May 1, 2024 Accepting new patients
County of Macomb CurrentSince May 1, 2024 Accepting new patients

Locations

19800 Hall Rd
Clinton Twp, MI 48038
Phone (586) 854-4804

3 Parklane Blvd
Ste 730W
Dearborn, MI 48126
Phone (313) 794-5653

30301 Northwestern Hwy
Ste 100
Farmington Hills, MI 48334
Phone (248) 549-4339

4410 W 13 Mile Rd
Royal Oak, MI 48073
Phone (248) 217-8066

25401 Harper Ave
St Clr Shores, MI 48081
Phone (586) 466-6912

12200 E 13 Mile Rd
Warren, MI 48093
Phone (586) 573-1810

12200 E 13 Mile Rd
Ste 200
Warren, MI 48093
Phone (586) 573-1810

Organizations & group practices 4

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": "1566864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1184272791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736515",
            "telephone_number": "313-255-8267",
            "fax_number": "313-242-0490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 E 13 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933093",
            "telephone_number": "313-255-8250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOONEY",
        "first_name": "INDIA",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-27",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401019217",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401019217",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401223867",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401019217",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6344",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "India_Mooney@judsoncenter.org",
            "affiliation": "N",
            "endpointDescription": "Business Email",
            "address_1": "12723 Telegraph Rd Ste 200",
            "city": "Redford",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482391489",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "India_Mooney@judsoncenter.org",
            "affiliation": "N",
            "endpointDescription": "Professional Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4410 W 13 Mile Rd",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480736515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

Verify at the official NPI Registry.