Nikole Mack, COUNSELOR TRAINEE CT

Primary specialty

CounselorTaxonomy code 101Y00000X

License

C.2304902-TRNE Issued in OH

Practice address

3951 Rocky River Dr
Cleveland, OH 44111-4154

Phone

(216) 332-9360

NPI assigned

May 25, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/reachbh/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Reach Counseling Services

  • Behavior Analyst
  • Brookpark, OH
  • NPI 1184422792

  Multi-Specialty

  NPD (past)
• Reach Counseling Services

  • Community/Behavioral Health Agency
  • Brookpark, OH
  • NPI 1932417193
  NPD (past)

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

{
    "created_epoch": "1684972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713484800000",
    "number": "1467144600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5445 SMITH RD",
            "city": "BROOKPARK",
            "state": "OH",
            "postal_code": "441422026",
            "telephone_number": "216-332-9360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3951 ROCKY RIVER DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441114154",
            "telephone_number": "216-332-9360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "NIKOLE",
        "credential": "COUNSELOR TRAINEE CT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-25",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "OH",
            "license": "APP000695832",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OH",
            "license": "APP000695832",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "OH",
            "license": "C.2304902-TRNE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janis Kiyono Mack
• June Mack, CNP
• Justin Ottis Mack, QMHS, CDCA,BA
• Lucilla Mack, RN
• Michael Mack
• Sharon D Mack, RPH
• Sharon Lynn Mack, CNP
• Steven Anthony Mack, RPH
• Jane M Mackall, CCC-A, MA
• Judith A Mackall, MD

• Counselor in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2024; 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.