Individual provider Active NPI

Jacqueline Mitchell, LPCC

  • Mental Health Counselor
  • Maysville, KY
National Provider Identifier
1295230654
Registry record updated Aug 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
279505 Issued in KY
Practice address
8018 Shelby St
Maysville, KY 41056-9433
Phone
(606) 584-9918
NPI assigned
Mar 28, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Mental Health Counselor 101YM0800X 279505 KY Primary

Addresses

Primary practice location

8018 Shelby St
Maysville, KY 41056-9433

Mailing address

8018 Shelby St
Maysville, KY 41056-9433
Phone (606) 584-9918

Other practice location 1

104 S Front Ave
Prestonsburg, KY 41653-1614
Phone (606) 886-8572

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240119001113 KY Practitioner - Mental Health Counselor 4183076706 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kentucky Counseling Center LLCGroup PAC ID 7618221300, 57 clinicians

Practice addresses (Care Compare)

1169 Eastern Pkwy
Suite 3328
Louisville, KY 40217-1415
Phone (855) 591-0092

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kentucky Counseling Center, LLC CurrentSince Oct 23, 2023 Accepting new patients

Locations

1169 Eastern Pkwy
Ste 3328
Louisville, KY 40217
Phone (205) 914-2526

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1295230654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8018 SHELBY ST",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "410569433",
            "telephone_number": "606-584-9918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8018 SHELBY ST",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "410569433",
            "telephone_number": "606-584-9918"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 S Front Ave",
            "address_purpose": "LOCATION",
            "city": "Prestonsburg",
            "state": "KY",
            "postal_code": "416531614",
            "country_code": "US",
            "telephone_number": "606-886-8572",
            "fax_number": "606-886-4433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "JACQUELINE",
        "name_prefix": "Ms.",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-28",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "KY",
            "license": "279505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maysville, KY

Sources for this page

Verify at the official NPI Registry.