Water's Edge Counseling Services, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6401011487 Issued in MI

Legal business name

WATER'S EDGE COUNSELING SERVICES, LLC

Practice address

71901 County Road 388
South Haven, MI 49090-9336

Phone

(269) 872-3625

NPI assigned

Aug 27, 2016

Organization subpart

No

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

Authorized official

Name

Mrs. Kelly Pinney Ellis, MA, LPC, BCPCNPI 1417189929

Title

Ceo, Therapist

Phone

(269) 214-1234

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Pinney Ellis, MA, LPC, BCPC

  • Professional Counselor
  • South Haven, MI
  • NPI 1417189929
  NPD (past) Authorized official

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

{
    "created_epoch": "1472256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472256000000",
    "number": "1447706759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71901 COUNTY ROAD 388",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490909336",
            "telephone_number": "269-872-3625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71901 COUNTY ROAD 388",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490909336",
            "telephone_number": "269-872-3625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATER'S EDGE COUNSELING SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-27",
        "last_updated": "2016-08-27",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "PINNEY",
        "authorized_official_title_or_position": "CEO, THERAPIST",
        "authorized_official_telephone_number": "269-214-1234",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA, LPC, BCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401011487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in South Haven, MI
• Providers in South Haven, MI by specialty
• Mental Health Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.