Active NPI
Jessica Earlywine, MS
- Mental Health Counselor
- Council Bluffs, IA
National Provider Identifier
1457765687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 073332
- Practice address
- 500 Willow Ave
Suite 305
Council Bluffs, IA 51503-0827 - Phone
- (712) 256-4420
- Fax
- (712) 256-4423
- NPI assigned
- Jun 16, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 073332 | IA | Primary |
Addresses
Primary practice location
500 Willow Ave
Suite 305
Council Bluffs, IA 51503-0827
Mailing address
500 Willow Ave
Suite 305
Council Bluffs, IA 51503-0827
Phone (712) 256-4420
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 073332 | Medicaid | IA |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 073332 | IA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402876800000",
"number": "1457765687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 WILLOW AVE",
"address_2": "SUITE 305",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515030827",
"telephone_number": "712-256-4420",
"fax_number": "712-256-4423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 WILLOW AVE",
"address_2": "SUITE 305",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515030827",
"telephone_number": "712-256-4420",
"fax_number": "712-256-4423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EARLYWINE",
"first_name": "JESSICA",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-16",
"last_updated": "2014-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IA",
"license": "073332",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "073332",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Council Bluffs, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.