Peg Jean Eppolito, LMHC, CADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

001693 Issued in IA

Practice address

3320 W 4TH St
Sioux City, IA 51103-3200

Phone

(712) 202-0777

Fax

(712) 202-0780

NPI assigned

Dec 4, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Peggy Jean Harrison Former name

Medicare fee-for-service enrollment

Enrolled in IA

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, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Heartland Family ServiceGroup PAC ID 7315833506, 14 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 and National Provider Directory roles.

• Heartland Family Service

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Council Bluffs, IA
  • NPI 1972343184
  Medicare reassignment Care Compare group NPD
• Heartland Family Service

  • Multi-Specialty Clinic/Center
  • Council Bluffs, IA
  • NPI 1447742036

  Addiction (Substance Use Disorder)

  NPD
• Heartland Family Service

  • Mental Health Counselor
  • Council Bluffs, IA
  • NPI 1639562069
  NPD

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

{
    "created_epoch": "1449187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449187200000",
    "number": "1467827212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 5TH ST",
            "address_2": "STE. 200",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011317",
            "telephone_number": "712-234-2300",
            "fax_number": "712-234-2398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 W 4TH ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511033200",
            "telephone_number": "712-202-0777",
            "fax_number": "712-202-0780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EPPOLITO",
        "first_name": "PEG",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "LMHC, CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-04",
        "last_updated": "2015-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IA",
            "license": "05204",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "001693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PEGGY",
            "last_name": "HARRISON",
            "middle_name": "JEAN",
            "credential": "LMHC, CADC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Sioux City, IA
• Providers in Sioux City, IA by specialty
• Mental Health Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2015; 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.