NPIMap

Individual provider Active NPI

Mandy J Kaisner, LPC

  • Professional Counselor
  • Leadville, CO
National Provider Identifier
1396877692
Registry record updated Apr 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
5826 Issued in NU
Practice address
714 Front St
Leadville, CO 80461-3921
Phone
(719) 486-0985
Fax
(719) 486-0986
NPI assigned
Mar 12, 2007
Last updated
Apr 4, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 5826 CO
Professional Counselor 101YP2500X 5826 NU Primary
Psychologist 103T00000X NU

Addresses

Primary practice location

714 Front St
Leadville, CO 80461-3921

Mailing address

3225 Independence Rd
Canon City, CO 81212-9380
Phone (719) 275-2351

Other names 1

  • Mandy J Baker Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5826COMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Solvista Health Corp. Current Accepting new patients
Solvista Health Corp. Current Accepting new patients

Locations

3225 Independence Rd
Canon City, CO 81212
Phone (719) 275-2351

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 32

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.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459728000000",
    "number": "1396877692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 INDEPENDENCE RD",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812129380",
            "telephone_number": "719-275-2351",
            "fax_number": "719-269-9386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 FRONT ST",
            "city": "LEADVILLE",
            "state": "CO",
            "postal_code": "804613921",
            "telephone_number": "719-486-0985",
            "fax_number": "719-486-0986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAISNER",
        "first_name": "MANDY",
        "middle_name": "J",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-12",
        "last_updated": "2016-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "5826",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": "5826",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANDY",
            "last_name": "BAKER",
            "middle_name": "J",
            "credential": "PSY PH D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Leadville, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; 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.