Jeremy Michael Waddell, MA, LMHCA, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

39002882A Issued in IN

Practice address

1308 N Main Street
Crown Point, IN 46307

Phone

(219) 663-6353

NPI assigned

May 25, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1400976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1235541244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1308 N MAIN ST",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463073278",
            "telephone_number": "410-610-1635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 N MAIN STREET",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "46307",
            "telephone_number": "219-663-6353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 N Main St",
            "address_purpose": "LOCATION",
            "city": "Crown Point",
            "state": "IN",
            "postal_code": "463073278",
            "country_code": "US",
            "telephone_number": "219-663-6353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "JEREMY",
        "middle_name": "MICHAEL",
        "credential": "MA, LMHCA, NCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-25",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "88000022A",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39002882A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Crown Point, IN
• Providers in Crown Point, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.