Active NPI
Sea Therapy LLC
- Community/Behavioral Health Agency
- Elkhart, IN
National Provider Identifier
1215467659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- License
- 309003032A
- Legal business name
- SEA THERAPY LLC
- Practice address
- 1004 Parkway Ave Ste D
Elkhart, IN 46516-9349 - Phone
- (574) 293-0005
- NPI assigned
- Jun 18, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stephanie K McIntosh Szabo, LMHC, LCAC
- Title
- Owner
- Phone
- (574) 612-4556
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 309003032A | IN | Primary |
| Community/Behavioral Health Agency | 251S00000X | 87000369A | IN |
Addresses
Primary practice location
1004 Parkway Ave Ste D
Elkhart, IN 46516-9349
Mailing address
29765 County Road 118
Elkhart, IN 46517-9392
Phone (574) 612-4556
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11844637 | Other | IN | CAQH |
National Provider Directory
National Provider DirectoryLocations
1004 Parkway Ave
Ste D
Elkhart, IN 46516
Phone (574) 293-0005
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Mental Health Counselor
- Elkhart, IN
- NPI 1467741215
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497744000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1499558400000",
"number": "1215467659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29765 COUNTY ROAD 118",
"city": "ELKHART",
"state": "IN",
"postal_code": "465179392",
"telephone_number": "574-612-4556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1004 PARKWAY AVE STE D",
"city": "ELKHART",
"state": "IN",
"postal_code": "465169349",
"telephone_number": "574-293-0005"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SEA THERAPY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-06-18",
"last_updated": "2017-07-09",
"status": "A",
"authorized_official_last_name": "MCINTOSH SZABO",
"authorized_official_first_name": "STEPHANIE",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "574-612-4556",
"authorized_official_credential": "LMHC, LCAC"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "IN",
"license": "309003032A",
"primary": true
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "IN",
"license": "87000369A",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11844637",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.