Mark Russell Ireland, LPC, LMAC
Individual provider Active NPI Mental Health Counselor · Hiawatha, KS
NPI 1457589665 · NPPES record last updated Apr 10, 2019
Key facts
- NPI
- 1457589665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 2112 (KS)
- Practice address
- 909 S 2ND St
Hiawatha, KS 66434-2774 - Phone
- (785) 742-7113
- NPI assigned
- Jun 25, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 27, 2025 through Jan 27, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2112 | KS | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychological Health Services, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2112 | KS | Yes |
Addresses
Primary practice location
909 S 2ND St
Hiawatha, KS 66434-2774
Mailing address
909 S 2ND St
Hiawatha, KS 66434-2774
Phone (785) 742-7113
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841281805 | Medicaid | KS |
Other providers in Hiawatha, KS
- Horizon Therapy Associates LLC
- Amber Howard
- Kindra Howard
- Katharine Elaine Hrencher
- Shelley Huppert
- Rachel Jackson
- Danielle A Jagels
- Adam Robert Jahnel
- Jessica Jarvis
- Kimberly Johansen
All providers in Hiawatha, KS · Mental Health Counselor in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.