Intentional Life Therapy

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

INTENTIONAL LIFE THERAPY

Practice address

10951 E Gypsy Lane Rd
Bowling Green, OH 43402-9565

Phone

(419) 913-4255

NPI assigned

Mar 17, 2022

Organization subpart

No

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

Authorized official

Name

Nicole Flores-McCuneNPI 1639166051

Title

Owner/Provider

Phone

(419) 913-4255

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 6

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

• Nicole Flores-McCune, LISW-S

  • Clinical Social Worker
  • Bowling Green, OH
  • NPI 1639166051
  Medicare reassignment NPD Authorized official
• Andria Leigh Doyle, PH.D.

  • Clinical Psychologist
  • Wooster, OH
  • NPI 1568568673
  NPD (past)
• Menwa Hope Gentle, IMFT

  • Marriage & Family Therapist
  • Bowling Green, OH
  • NPI 1497477392
  NPD (past)
• Francesca A Leass, LISW

  • Clinical Social Worker
  • Findlay, OH
  • NPI 1902140379
  NPD (past)
• Johnathon W Redmon, LISW

  • Clinical Social Worker
  • Findlay, OH
  • NPI 1104493964
  NPD (past)
• Rachel Louise Tincher, MS LPC CTP

  • Professional Counselor
  • Toledo, OH
  • NPI 1144713074
  NPD (past)

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

{
    "created_epoch": "1647475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650844800000",
    "number": "1265180285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9895 HUFFMAN RD",
            "city": "PORTAGE",
            "state": "OH",
            "postal_code": "434519739",
            "telephone_number": "419-913-4255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10951 E GYPSY LANE RD",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434029565",
            "telephone_number": "419-913-4255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 N Summit St",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "OH",
            "postal_code": "434022527",
            "country_code": "US",
            "telephone_number": "419-913-4255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTENTIONAL LIFE THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-17",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A",
        "authorized_official_last_name": "FLORES-MCCUNE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "419-913-4255"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenny Lynne Hutton, MPAS, PA-C
• Bonnie Iler, M.A. - LPCC
• Mustafa Ilgin III, MSW LSW
• Devin Ashley Inbody, RPH
• Caleigh Instone
• Interim Healthcare of Northwestern Ohio Inc.
• Irb Medical Equipment, LLC
• Jack a. Whittaker D.D.S., Inc.
• Taylor Jackson
• Timara Christina Jackson

• Clinical Social Worker in Bowling Green, OH
• Providers in Bowling Green, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.