Keri Ellen McCall

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

88000135A Issued in IN

Practice address

3711 Rupp Dr Ste 208
Fort Wayne, IN 46815-4523

Phone

(260) 217-5902

Fax

(260) 202-5202

NPI assigned

Jun 27, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1235659632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 BOONE ST",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468083708",
            "telephone_number": "260-217-5902",
            "fax_number": "260-202-5202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3711 RUPP DR STE 208",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468154523",
            "telephone_number": "260-217-5902",
            "fax_number": "260-202-5202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "809 High St",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IN",
            "postal_code": "467332324",
            "country_code": "US",
            "telephone_number": "260-724-9669",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "909 E State Blvd",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468053404",
            "country_code": "US",
            "telephone_number": "260-481-2700",
            "fax_number": "260-481-2838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCALL",
        "first_name": "KERI",
        "middle_name": "ELLEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-27",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39003263A",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "88000135A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300065057",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "spruce.care/e1er85008cj800",
            "affiliation": "N",
            "address_1": "3711 Rupp Dr Ste 208",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468154523",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shonte Patrice McBride
• Tiffany Kaiser McBride, L-ATC
• Neva R McCague, FNP
• Kelli L McCain, NP
• Gerald Dean McCaleb
• Arieon McCarter
• Jennifer Nicole McCarthy, PHARMD
• Lyn McCarthy, MA, BCBA
• Nicholas McCarthy, DDS
• Gabrielle McCarty, RBT

• Mental Health Counselor in Fort Wayne, IN
• Providers in Fort Wayne, 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 Dec 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.