Kimberly E Mickelson, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

17777 Issued in TX

Practice address

2303 Raun LN
El Campo, TX 77437-2127

Phone

(979) 541-3375

NPI assigned

Aug 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

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, 2020

Medicare assignment

May accept Medicare assignment

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.

• Matagorda Episcopal Health Outreach Program Corporation

  • Federally Qualified Health Center (FQHC)
  • Bay City, TX
  • NPI 1598024788
  Medicare reassignment NPD
• Matagorda Episcopal Health Outreach Program

  • Federally Qualified Health Center (FQHC)
  • Wharton, TX
  • NPI 1205449386
  NPD
• Matagorda Episcopal Health Outreach Program

  • Federally Qualified Health Center (FQHC)
  • Wharton, TX
  • NPI 1568075638
  NPD
• Matagorda Episcopal Health Outreach Program

  • Federally Qualified Health Center (FQHC)
  • Palacios, TX
  • NPI 1467009092
  NPD (past)

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209945600000",
    "number": "1487768594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2303 RAUN LN",
            "city": "EL CAMPO",
            "state": "TX",
            "postal_code": "774372127",
            "telephone_number": "979-541-3375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2303 RAUN LN",
            "city": "EL CAMPO",
            "state": "TX",
            "postal_code": "774372127",
            "telephone_number": "979-541-3375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "KIMBERLY",
        "middle_name": "E",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-18",
        "last_updated": "2008-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "17777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOCS MCD",
            "identifier": "164430404",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOMHA MCD",
            "identifier": "164430403",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164430402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colleen Martha Melburn, M.D.
• Melissa a Kainer Erwin, M.D., P.a.
• Memeeha, LLC
• Memorial Hermann Health System
• Jean Ann Merck, LCP
• Mid Coast Health System
• Modern Dental
• Oakbend Medical Center
• Oakbend Medical Center
• Robert George Ogdee, MD

• Mental Health Counselor in El Campo, TX
• Providers in El Campo, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; 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.