Active NPI
Sue Stolkin, LMFT
- Marriage & Family Therapist
- Indianapolis, IN
National Provider Identifier
1508052317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 35001344A
- Practice address
- 7165 Clearvista Way
Indianapolis, IN 46256-4621 - Phone
- (317) 621-7561
- Fax
- (317) 355-6096
- NPI assigned
- Sep 15, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 39000756A | IN | |
| Marriage & Family Therapist | 106H00000X | 35001344A | IN | Primary |
Addresses
Primary practice location
7165 Clearvista Way
Indianapolis, IN 46256-4621
Mailing address
6626 E 75TH Street
Ste 500
Indianaplis, IN 46250-2890
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100270530A | Medicaid | IN | |
| 1031373 | Other | IN | CIGNA |
| 372491 | Other | IN | MANAGED HEALTH NETWORK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 26, 2024 through Apr 26, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39000756A | IN | MD | Mental Health Counselor |
| 35001344A | IN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449532800000",
"number": "1508052317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6626 E 75TH STREET",
"address_2": "STE 500",
"city": "INDIANAPLIS",
"state": "IN",
"postal_code": "462502890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7165 CLEARVISTA WAY",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462564621",
"telephone_number": "317-621-7561",
"fax_number": "317-355-6096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOLKIN",
"first_name": "SUE",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-15",
"last_updated": "2015-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "39000756A",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "IN",
"license": "35001344A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100270530A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1031373",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANAGED HEALTH NETWORK",
"identifier": "372491",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.