Individual provider Active NPI

Christine S Simpson, LCSW

  • Clinical Social Worker
  • Kokomo, IN
National Provider Identifier
1306972401
Registry record updated Aug 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34004650A Issued in IN
Practice address
1810 Dogwood Dr
Kokomo, IN 46902-5737
Phone
(765) 553-5691
Fax
(765) 553-5772
NPI assigned
Feb 26, 2007
Last updated
Aug 26, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 34004650A IN Primary

Addresses

Primary practice location

1810 Dogwood Dr
Kokomo, IN 46902-5737

Mailing address

9255 W 00 NS
Kokomo, IN 46901
Phone (765) 434-3531

Other identifiers 1

IdentifierTypeStateIssuer
100154150AMedicaidIN

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

LicenseStateTypeSpecialty
34004650AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mending Minds, LLC CurrentSince Mar 1, 2022 Accepting new patients

Locations

702 W Alto Rd
Kokomo, IN 46902
Phone (765) 453-7422

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24167/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598400000000",
    "number": "1306972401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9255 W 00 NS",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "46901",
            "telephone_number": "765-434-3531",
            "fax_number": "765-553-5772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 DOGWOOD DR",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469025737",
            "telephone_number": "765-553-5691",
            "fax_number": "765-553-5772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMPSON",
        "first_name": "CHRISTINE",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-26",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34004650A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100154150A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kokomo, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; 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.