NPIMap

Organization Active NPI

Starkville Wellness Group

  • Mental Health Counselor
  • Starkville, MS
National Provider Identifier
1437763240
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
STARKVILLE WELLNESS GROUP
Practice address
100 Starr Ave #K
Starkville, MS 39759
Phone
(972) 898-2394
NPI assigned
Aug 31, 2020
Last updated
Jun 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

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

Authorized official

Name
Mrs. Mary Elizabeth Ketchum, LPCNPI 1659867307
Title
LPC, Owner
Phone
(662) 425-1051

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
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

100 Starr Ave #K
Starkville, MS 39759

Mailing address

100 Starr Ave #K
Starkville, MS 39759
Phone (972) 898-2394

Other identifiers 1

IdentifierTypeStateIssuer
04678598MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230127001982 MS Part B Supplier - Clinic/Group Practice 3072982545 Receives reassigned benefits from 13 practitioners
Practice locations: Columbus, MS; Grenada, MS; Starkville, MS

National Provider Directory

National Provider Directory

Locations

28 Glenwood Dr
Ste 1
Columbus, MS 39705
Phone (601) 941-7754

1350 Sunset Dr
Ste D
Grenada, MS 38901
Phone (662) 340-5947

100 Starr Ave
Ste K
Starkville, MS 39759
Phone (662) 340-5947

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1598832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1437763240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 STARR AVE #K",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "39759",
            "telephone_number": "972-898-2394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 STARR AVE #K",
            "city": "STARKVILLE",
            "state": "MS",
            "postal_code": "39759",
            "telephone_number": "972-898-2394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STARKVILLE WELLNESS GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-31",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A",
        "authorized_official_last_name": "KETCHUM",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "LPC, OWNER",
        "authorized_official_telephone_number": "662-425-1051",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04678598",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Starkville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; 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.