Individual provider Active NPI

Victoria Jay-Ellen Spurgeon

  • Mental Health Counselor
  • Fairfield, OH
National Provider Identifier
1235887019
Registry record updated Mar 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
C.2203977 Issued in OH
Practice address
1251 Nilles Rd Ste 5
Fairfield, OH 45014-7205
Phone
(888) 830-0347
NPI assigned
Mar 11, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X C.2203977 OH Primary

Addresses

Primary practice location

1251 Nilles Rd Ste 5
Fairfield, OH 45014-7205

Mailing address

429 Ewa Yea St
Vermilion, OH 44089-3201
Phone (937) 830-9062

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
C.2203977OHMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1646956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646956800000",
    "number": "1235887019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "429 EWA YEA ST",
            "city": "VERMILION",
            "state": "OH",
            "postal_code": "440893201",
            "telephone_number": "937-830-9062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1251 NILLES RD STE 5",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "450147205",
            "telephone_number": "888-830-0347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPURGEON",
        "first_name": "VICTORIA",
        "middle_name": "JAY-ELLEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-11",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C.2203977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.