Elizabeth Anne Mellin, PHD, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC004002 Issued in GA

Practice address

1168 Ellis Hollow Rd
Ithaca, NY 14850-2946

Phone

(814) 769-3399

NPI assigned

Apr 21, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Mental Health Counselor

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1587427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587427200000",
    "number": "1366062234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1168 ELLIS HOLLOW RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148502946",
            "telephone_number": "814-769-3399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1168 ELLIS HOLLOW RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148502946",
            "telephone_number": "814-769-3399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLIN",
        "first_name": "ELIZABETH",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "PHD, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-21",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC004002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PROFESSIONAL COUNSELOR",
            "identifier": "LPC004002",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Ithaca",
            "affiliation": "N",
            "endpointDescription": "Practice location",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1168 Ellis Hollow Rd",
            "city": "Ithaca",
            "state": "NY",
            "country_code": "US",
            "postal_code": "148502946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.