Lydia Buckingham
Individual provider Active NPI Mental Health Counselor · Perry, IA
NPI 1245911916 · NPPES record last updated Jul 26, 2023
Key facts
- NPI
- 1245911916
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 121149 (IA)
- Practice address
- 1220 Willis Ave Ste 12
Perry, IA 50220-1662 - Phone
- (515) 992-6638
- NPI assigned
- Jul 26, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Stephanie Heitman
Practice addresses (Care Compare)
1220 Willis Ave
Suite 12
Perry, IA 50220-1662
Phone (515) 992-6638
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260527003933 | IA | Practitioner - Mental Health Counselor | 2668942905 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 121149 | IA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stephanie Heitman | Mental Health | Current |
Accepting new patients |
Locations
1220 Willis Ave
Ste 12
Perry, IA 50220
Phone (515) 992-6638
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 121149 | IA | Yes |
Addresses
Primary practice location
1220 Willis Ave Ste 12
Perry, IA 50220-1662
Mailing address
PO Box 253
Perry, IA 50220-0253
Phone (151) 992-6638
Other providers in Perry, IA
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- Guadalupe Chavez
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All providers in Perry, IA · Mental Health Counselor in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.