Active NPI
Ty Bond Mullins
- Addiction (Substance Use Disorder) Counselor
- Ironton, OH
National Provider Identifier
1245920362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CDCA.185208
- Practice address
- 202 N 5TH St
Ironton, OH 45638-1186 - Phone
- (740) 534-2100
- NPI assigned
- May 11, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Peer Specialist | 175T00000X | APS.004270 | OH | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CDCA.185208 | OH | Primary |
Addresses
Primary practice location
202 N 5TH St
Ironton, OH 45638-1186
Mailing address
202 N 5TH St
Ironton, OH 45638-1186
Phone (740) 534-2100
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
| License | State | Type | Specialty |
|---|---|---|---|
| CDCA.185208 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| APS.004270 | OH | MD | Peer Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mahajan Therapeutics, LLC | Past | Accepting new patients | |
| Mahajan Therapeutics, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Dayton, OH
- NPI 1669531810
-
- Community/Behavioral Health Agency
- Portsmouth, OH
- NPI 1952734469
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697500800000",
"number": "1245920362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 N 5TH ST",
"city": "IRONTON",
"state": "OH",
"postal_code": "456381186",
"telephone_number": "740-534-2100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 N 5TH ST",
"city": "IRONTON",
"state": "OH",
"postal_code": "456381186",
"telephone_number": "740-534-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLINS",
"first_name": "TY",
"middle_name": "BOND",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-11",
"last_updated": "2023-10-17",
"certification_date": "2023-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OH",
"license": "APS.004270",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "CDCA.185208",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ironton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.