Teresa S. Dement, LPCC, LICDC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

E.1901231 Issued in OH

Practice address

1220 W Hunter St
Logan, OH 43138-1012

Phone

(740) 205-2999

Fax

(740) 216-4501

NPI assigned

Feb 15, 2017

Last updated

Aug 12, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Common Bond Counseling, LLCGroup PAC ID 8022422096, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Common Bond Counseling, LLC

  • Addiction (Substance Use Disorder) Counselor
  • Logan, OH
  • NPI 1326542507
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1487116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1457890097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 W HUNTER ST",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "431381012",
            "telephone_number": "740-205-2999",
            "fax_number": "740-216-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 W HUNTER ST",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "431381012",
            "telephone_number": "740-205-2999",
            "fax_number": "740-216-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMENT",
        "first_name": "TERESA",
        "middle_name": "S.",
        "credential": "LPCC, LICDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-15",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LICDC.161833",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.1901231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keirstin Rylie Darst, CPHT
• Kimberly Davis
• Tracie Dearing
• Lisa Degarmo
• Gretchen Marie Del Valle, RPH
• Ashley Demoss, DENTAL ASST.
• Cathy Sue Dennison, LPN
• Nicholas Devol
• John Duffy Dewalt, D.O.
• Diles Logan Hearing Center, L.L.C.

• Mental Health Counselor in Logan, OH
• Providers in Logan, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.