Cody Allen Mitchem

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

Practice address

502 McCarty LN Ste 1
Jackson, OH 45640-7025

Phone

(740) 577-9003

Fax

(740) 577-9184

NPI assigned

Sep 20, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1695168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1356129332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 MCCARTY LN STE 1",
            "city": "JACKSON",
            "state": "OH",
            "postal_code": "456407025",
            "telephone_number": "740-577-9003",
            "fax_number": "740-577-9184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 MCCARTY LN STE 1",
            "city": "JACKSON",
            "state": "OH",
            "postal_code": "456407025",
            "telephone_number": "740-577-9003",
            "fax_number": "740-577-9184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHEM",
        "first_name": "CODY",
        "middle_name": "ALLEN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-20",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory Derrick Meredith, DDS
• Kisha Kai Michael
• Charman Lyn McCain Miller, NP
• Christopher Joseph Miller
• Victoria R Miller
• Milad Modarresi
• Monarch Counseling and Consultation LLC
• Monarch: Wings of Kyla Foundation
• Karen Teresa Monroe
• Bailee G Montgomery

• Addiction (Substance Use Disorder) Psychologist in Jackson, OH
• Providers in Jackson, OH by specialty
• Addiction (Substance Use Disorder) Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; 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.