NPIMap

Organization Active NPI

Family & Children's Center of Counseling and Development Services Inc

  • Psychologist
  • South Bend, IN
National Provider Identifier
1184612137
Registry record updated Oct 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
FAMILY & CHILDREN'S CENTER OF COUNSELING AND DEVELOPMENT SERVICES INC
Practice address
611 Lincolnway East
South Bend, IN 46601-3220
Phone
(574) 232-2255
Fax
(574) 232-8968
NPI assigned
Oct 12, 2005
Last updated
Oct 31, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2012

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

Authorized official

Name
Ms. Patricia Hancock, LCSWNPI 1093872236
Title
Clinical Director
Phone
(574) 232-2255

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Psychologist 103T00000X Primary
Clinical Social Worker 1041C0700X

Addresses

Primary practice location

611 Lincolnway East
South Bend, IN 46601-3220

Mailing address

611 Lincolnway East
South Bend, IN 46601-3220
Phone (574) 232-2255

Other identifiers 3

IdentifierTypeStateIssuer
000000184548OtherINANTHEM
200264420MedicaidIN
236961000OtherINMAGELLAN

National Provider Directory

National Provider Directory

Locations

500 N Nappanee St
Ste 4A
Elkhart, IN 46514
Phone (219) 523-3347

105 E Jefferson Blvd
Ste 325
South Bend, IN 46601
Phone (219) 287-2671

315 W Jefferson Blvd
South Bend, IN 46601
Phone (574) 968-9660

611 Lincoln Way E
South Bend, IN 46601
Phone (574) 232-2255

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351641600000",
    "number": "1184612137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 LINCOLNWAY EAST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466013220",
            "telephone_number": "574-232-2255",
            "fax_number": "574-232-8968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 LINCOLNWAY EAST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466013220",
            "telephone_number": "574-232-2255",
            "fax_number": "574-232-8968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY & CHILDREN'S CENTER OF COUNSELING AND DEVELOPMENT SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2012-10-31",
        "status": "A",
        "authorized_official_last_name": "HANCOCK",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "574-232-2255",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000184548",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200264420",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "236961000",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2012; 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.