Lindsay P. South, Ma PLLC
Organization Active NPI Mental Health Counselor · Portage, MI
NPI 1346600947 · NPPES record last updated Mar 8, 2016
Key facts
- NPI
- 1346600947
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 6401005843 (MI)
- Legal business name
- LINDSAY P. SOUTH, MA PLLC
- Practice address
- 1591 W Centre Ave
Suite 103
Portage, MI 49024-6314 - Phone
- (269) 323-2553
- NPI assigned
- Feb 25, 2016
- Organization subpart
- No
Authorized official
- Name
- Connie E. Webb
- Title
- Office Manager
- Phone
- (269) 303-3835
Practitioners 4
-
Shannon E. Aardema, LPC
-
Lukas Lee Pederson, LPC
-
Gillian K Cupp, RN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240521000521 | MI | Part B Supplier - Clinic/Group Practice | 7315389582 |
Receives reassigned benefits from 3 practitioners Practice locations: Portage, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | 6401005843 | MI | Yes |
Addresses
Primary practice location
1591 W Centre Ave
Suite 103
Portage, MI 49024-6314
Mailing address
1591 W. Centre Avenue
Suite 103
Portage, MI 49024-5342
Phone (269) 323-2553
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942396205 | Other | MI | INDIVIDUAL NPI |
Other providers in Portage, MI
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- Jessica Joy Like
- Deedee Lincoln
- Nathan Linden
- Molly Linebaugh
- Taylor Anne Linn
- Angela Dawn Liskovec
- Brian Nathaniel Little
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All providers in Portage, MI · Mental Health Counselor in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.