Individual provider Active NPI

Maranda Rae Houser, MSW, LCSW

  • Mental Health Counselor
  • Goshen, IN
National Provider Identifier
1366039190
Registry record updated Dec 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
99102035A Issued in IN
Practice address
21764 Omega CT
Goshen, IN 46528-7809
Phone
(574) 747-7429
NPI assigned
Dec 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 99102035A IN Primary

Addresses

Primary practice location

21764 Omega CT
Goshen, IN 46528-7809

Mailing address

23463 Greenwood Blvd
Elkhart, IN 46516-6140
Phone (574) 747-7429

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20240618003254 IN Practitioner - Clinical Social Worker 2466995428 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
99102035AINMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Crossroads Therapy Practice LLC CurrentSince Jan 17, 2021 Accepting new patients
Grow Healthcare Group PA Mental Health CurrentSince Apr 23, 2024 Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

21764 Omega Ct
Goshen, IN 46528
Phone (574) 875-4227

9465 Counselors Row
Ste 200
Indianapolis, IN 46240
Phone (463) 220-4646

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1609113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1366039190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23463 GREENWOOD BLVD",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465166140",
            "telephone_number": "574-747-7429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21764 OMEGA CT",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465287809",
            "telephone_number": "574-747-7429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOUSER",
        "first_name": "MARANDA",
        "middle_name": "RAE",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-28",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "99102035A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goshen, IN

Sources for this page

Verify at the official NPI Registry.