Debra Polley, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

106 Three Rivers N
Fort Wayne, IN 46802-1312

Phone

(260) 426-5778

Fax

(260) 423-6412

NPI assigned

Nov 1, 2006

Last updated

Jul 8, 2007By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Black & Associates Counseling Services Inc

  • Mental Health Counselor
  • Fort Wayne, IN
  • NPI 1548359086
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1518044304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 THREE RIVERS N",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468021312",
            "telephone_number": "260-426-5778",
            "fax_number": "260-423-6412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 THREE RIVERS N",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468021312",
            "telephone_number": "260-426-5778",
            "fax_number": "260-423-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLLEY",
        "first_name": "DEBRA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Lyn Poiry
• Kara Poley
• Samuel Poling, DPT
• Rita Irene Polivick, M.S., LCSW,
• Gregg S Pollander, MD
• David L Pollifrone, MD
• Benjamin Pollock, MS
• Cole Matthew Polnow, PA
• Jessica Eileen Polubinsky, LMHC
• Stephanie Pomfred

• Mental Health Counselor in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.