NPIMap

Organization Active NPI

Michiana Counseling Group, LLC

  • Clinical Social Worker
  • Elkhart, IN
National Provider Identifier
1396180659
Registry record updated Apr 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34003589A Issued in IN
Legal business name
MICHIANA COUNSELING GROUP, LLC
Practice address
56218 Parkway Ave
Suite B
Elkhart, IN 46516-9326
Phone
(574) 293-0005
Fax
(574) 293-0019
NPI assigned
Apr 30, 2013
Last updated
Apr 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2013

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

Authorized official

Name
Jessica L. Lala, LCSWNPI 1720342983
Title
Licensed Clinical Social Worker
Phone
(574) 344-7941

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 34003589A IN Primary

Addresses

Primary practice location

56218 Parkway Ave
Suite B
Elkhart, IN 46516-9326

Mailing address

56218 Parkway Ave
Suite B
Elkhart, IN 46516-9326
Phone (574) 293-0005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130807000902 IN Part B Supplier - Clinic/Group Practice 0941442784 Receives reassigned benefits from 1 practitioner
Practice locations: Goshen, IN

National Provider Directory

National Provider Directory

Locations

56218 Parkway Ave
Ste D
Elkhart, IN 46516
Phone (574) 293-0005

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1367280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367280000000",
    "number": "1396180659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56218 PARKWAY AVE",
            "address_2": "SUITE B",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465169326",
            "telephone_number": "574-293-0005",
            "fax_number": "574-293-0019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56218 PARKWAY AVE",
            "address_2": "SUITE B",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465169326",
            "telephone_number": "574-293-0005",
            "fax_number": "574-293-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIANA COUNSELING GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-30",
        "last_updated": "2013-04-30",
        "status": "A",
        "authorized_official_last_name": "LALA",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "574-344-7941",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34003589A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkhart, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.