NPIMap

Organization Active NPI

Rachel Mickelson

  • Clinical Psychologist
  • South Bend, IN
National Provider Identifier
1245585157
Registry record updated Jul 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
20042493A Issued in IN
Legal business name
RACHEL MICKELSON
Practice address
2106 Ironwood Cir
South Bend, IN 46635-1864
Phone
(574) 243-9370
NPI assigned
Jul 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2012

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

Authorized official

Name
Rachel Lynn Mickelson, PSYD, HSPPNPI 1447558168
Title
Clinical Psychologist
Phone
(574) 243-9370

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 20042493A IN Primary

Addresses

Primary practice location

2106 Ironwood Cir
South Bend, IN 46635-1864

Mailing address

2106 Ironwood Cir
South Bend, IN 46635-1864

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342483200000",
    "number": "1245585157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2106 IRONWOOD CIR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2106 IRONWOOD CIR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351864",
            "telephone_number": "574-243-9370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RACHEL MICKELSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-17",
        "last_updated": "2012-07-17",
        "status": "A",
        "authorized_official_last_name": "MICKELSON",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "574-243-9370",
        "authorized_official_credential": "PSYD, HSPP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20042493A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2012; 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.