Individual provider Active NPI

Melissa M Clendaniel, MS, NCC, LACMH

  • Mental Health Counselor
  • Rehoboth Beach, DE
National Provider Identifier
1427699552
Registry record updated Sep 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
AC-0000143
Practice address
400 Midway Dr
Rehoboth Beach, DE 19971-9639
Phone
(302) 249-0754
NPI assigned
Sep 30, 2019
Last updated
Sep 30, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2019

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 AC-0000143 Primary

Addresses

Primary practice location

400 Midway Dr
Rehoboth Beach, DE 19971-9639

Mailing address

400 Midway Dr
Rehoboth Beach, DE 19971-9639
Phone (302) 249-0754

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
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
I20240515002374 DE Practitioner - Mental Health Counselor 1153762653 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of Mind Counseling Services, LLCGroup PAC ID 6901277706, 13 clinicians

Practice addresses (Care Compare)

610 Marshall St
Milford, DE 19963-2308
Phone (302) 359-3734

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mind Counseling Services, LLC Mental Health CurrentSince Mar 18, 2024 Accepting new patients

Locations

610 Marshall St
Milford, DE 19963
Phone (302) 359-3734

Organizations & group practices 1

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": "1569801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569801600000",
    "number": "1427699552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MIDWAY DR",
            "city": "REHOBOTH BEACH",
            "state": "DE",
            "postal_code": "199719639",
            "telephone_number": "302-249-0754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MIDWAY DR",
            "city": "REHOBOTH BEACH",
            "state": "DE",
            "postal_code": "199719639",
            "telephone_number": "302-249-0754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLENDANIEL",
        "first_name": "MELISSA",
        "middle_name": "M",
        "credential": "MS, NCC, LACMH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-30",
        "last_updated": "2019-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": "AC-0000143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rehoboth Beach, DE

Sources for this page

Verify at the official NPI Registry.