Patrick J Chesebrough, LCAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

87001654A Issued in IN

Practice address

4618 E State Blvd Ste 300
Fort Wayne, IN 46815-6966

Phone

(260) 373-0213

Fax

(260) 373-0218

NPI assigned

Jun 22, 2021

Last updated

Jun 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cross Connections, Inc

  • Mental Health Counselor
  • Fort Wayne, IN
  • NPI 1285112060

  Addiction (Substance Use Disorder)

  NPD

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1265001457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4618 E STATE BLVD STE 300",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468156966",
            "telephone_number": "260-373-0213",
            "fax_number": "260-373-0218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4618 E STATE BLVD STE 300",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468156966",
            "telephone_number": "260-373-0213",
            "fax_number": "260-373-0218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHESEBROUGH",
        "first_name": "PATRICK",
        "middle_name": "J",
        "credential": "LCAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-22",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "87001654A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• James H Cheviron, LCSW
• Madhavi Chilakamarri, MD
• Vijay K. Chilakamarri, MD

• Addiction (Substance Use Disorder) Counselor in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Addiction (Substance Use Disorder) Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; 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.