Center for Brief Therapy PC

Primary specialty

Prescribing (Medical) PsychologistTaxonomy code 103TP0016X

License

70000153A Issued in IN

Legal business name

CENTER FOR BRIEF THERAPY PC

Doing business as

Indiana Center for Cognitive Behavior Therapy

Practice address

423 Airport N. Office Park
Ft. Wayne, IN 46825-6704

Phone

(260) 969-5583

Fax

(260) 969-5584

NPI assigned

Jun 18, 2007

Last updated

Apr 23, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sharon E Freeman Clevenger, PMHCNS-BC

Title

Owner

Phone

(260) 969-5583

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Indiana Center for Cognitive Behavior Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

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, and the practitioner matching its NPPES authorized official.

• Sharon Freeman Clevenger, MA, MSN, PMHCNS-BC

  • Psychiatric/Mental Health Clinical Nurse Specialist
  • Fort Wayne, IN
  • NPI 1174527899
  Medicare reassignment
• Lydia Allcock, LMHC

  • Mental Health Counselor
  • Fort Wayne, IN
  • NPI 1285313999
  NPD
• Janet M. Eggiman, LMFT

  • Marriage & Family Therapist
  • Fort Wayne, IN
  • NPI 1962502328
  NPD (past)
• Kurt M. Hoffman, PSY.D., HSPP

  • Clinical Psychologist
  • Fort Wayne, IN
  • NPI 1477522282
  NPD (past)
• Holly R Lichtsinn, LCSW

  • Social Worker
  • Fort Wayne, IN
  • NPI 1699829648
  NPD (past)
• Veronica Renee Sanderson, LMHC

  • Mental Health Counselor
  • Fort Wayne, IN
  • NPI 1457971285
  NPD (past)

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555977600000",
    "number": "1285839480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "423 AIRPORT N. OFFICE PARK",
            "city": "FORT. WAYNE",
            "state": "IN",
            "postal_code": "468256704",
            "telephone_number": "260-969-5583",
            "fax_number": "260-969-5584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "423 AIRPORT N. OFFICE PARK",
            "city": "FT. WAYNE",
            "state": "IN",
            "postal_code": "468256704",
            "telephone_number": "260-969-5583",
            "fax_number": "260-969-5584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR BRIEF THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-18",
        "last_updated": "2019-04-23",
        "status": "A",
        "authorized_official_last_name": "FREEMAN CLEVENGER",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-969-5583",
        "authorized_official_credential": "PMHCNS-BC"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "IN",
            "license": "20042050A",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IN",
            "license": "35001565A",
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "IN",
            "license": "70000153A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "386107",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "376137",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7585825",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indiana Center for Cognitive Behavior Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Prescribing (Medical) Psychologist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Prescribing (Medical) Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; 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.