NPIMap

Jessica Brown

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Ashtabula, OH

NPI 1194420653 · NPPES record last updated Apr 4, 2023

Key facts

NPI
1194420653
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
CDCA.181749 (OH)
Practice address
3418 Lake Ave
Ashtabula, OH 44004-5763
Phone
(440) 650-5030
NPI assigned
Apr 4, 2023
Sex
Female
Sole proprietor
Yes

Organizations & group practices 2

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
CDCA.181749OHMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Empowering Independence LLC Current Accepting new patients
Square One Health LLC Current
since Apr 9, 2023		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor
Group: 193400000X SINGLE SPECIALTY GROUP		 101YA0400X CDCA.181749 OH Yes

Addresses

Primary practice location

3418 Lake Ave
Ashtabula, OH 44004-5763

Mailing address

3418 Lake Ave
Ashtabula, OH 44004-5763

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 4, 2023.

{
    "created_epoch": "1680566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680566400000",
    "number": "1194420653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3418 LAKE AVE",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440045763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3418 LAKE AVE",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440045763",
            "telephone_number": "440-650-5030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "JESSICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-04",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.181749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashtabula, OH

All providers in Ashtabula, OH · Addiction (Substance Use Disorder) Counselor in Ohio

Sources for this page

Verify at the official NPI Registry.