Active NPI
Terry Southwick, LPCC
- Professional Counselor
- Columbus, OH
National Provider Identifier
1255484358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- E1705
- Practice address
- 136 Northwoods Blvd
B1
Columbus, OH 43235-4728 - Phone
- (614) 296-6163
- Fax
- (614) 725-1651
- NPI assigned
- Jan 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | E1705 | OH | Primary |
Addresses
Primary practice location
136 Northwoods Blvd
B1
Columbus, OH 43235-4728
Mailing address
136 Northwoods Blvd
B1
Columbus, OH 43235-4728
Phone (614) 296-6163
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E1705 | OH | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shana Kemp-Price Counseling Associates Dba Modern Therapy | Past | Accepting new patients |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300320000000",
"number": "1255484358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "136 NORTHWOODS BLVD",
"address_2": "B1",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432354728",
"telephone_number": "614-296-6163",
"fax_number": "614-725-1651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "136 NORTHWOODS BLVD",
"address_2": "B1",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432354728",
"telephone_number": "614-296-6163",
"fax_number": "614-725-1651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTHWICK",
"first_name": "TERRY",
"credential": "LPCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-19",
"last_updated": "2011-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "E1705",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.