Individual provider Active NPI

Heidi Nichole Booth, LPCC

  • Professional Counselor
  • Bay Village, OH
National Provider Identifier
1386396513
Registry record updated May 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
E.2404005 Issued in OH
Practice address
600 Dover Center Rd
Bay Village, OH 44140-3310
Phone
(440) 742-4425
Fax
(440) 635-3809
NPI assigned
Jan 19, 2022
Last updated
May 28, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X E.2404005 OH Primary

Addresses

Primary practice location

600 Dover Center Rd
Bay Village, OH 44140-3310

Mailing address

600 Dover Center Rd
Bay Village, OH 44140-3310
Phone (419) 624-2427

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20240412001411 OH Practitioner - Mental Health Counselor 8820437627 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
May accept Medicare assignment
Group practices
Phoenix Counseling Center LLCGroup PAC ID 3577902451, 6 clinicians

Practice addresses (Care Compare)

33480 Liberty Pkwy
North Ridgeville, OH 44039-2670
Phone (440) 732-5252

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
E.2404005OHMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Counseling Center LLC Professional CurrentSince Jan 11, 2024 Accepting new patients
Phoenix Counseling Center LLC Past Accepting new patients

Locations

33480 Liberty Pkwy
North Ridgeville, OH 44039
Phone (440) 732-5252

6180 Emerald St
North Ridgeville, OH 44039
Phone (216) 327-7372

23550 Center Ridge Rd
Ste 102
Westlake, OH 44145
Phone (440) 732-5252

Organizations & group practices 3

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": "1642550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779926400000",
    "number": "1386396513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 DOVER CENTER RD",
            "city": "BAY VILLAGE",
            "state": "OH",
            "postal_code": "441403310",
            "telephone_number": "419-624-2427",
            "fax_number": "440-635-3809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 DOVER CENTER RD",
            "city": "BAY VILLAGE",
            "state": "OH",
            "postal_code": "441403310",
            "telephone_number": "440-742-4425",
            "fax_number": "440-635-3809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "HEIDI",
        "middle_name": "NICHOLE",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-19",
        "last_updated": "2026-05-28",
        "certification_date": "2026-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.2404005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Village, OH

Sources for this page

Verify at the official NPI Registry.