Jennifer Mannino, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401222784 Issued in MI

Practice address

127 N River St
Fenton, MI 48430-3800

Phone

(810) 309-9355

Fax

(810) 750-1152

NPI assigned

Jul 21, 2022

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 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

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, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

J Flack PSYD PCGroup PAC ID 0547426264, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• J Flack PSYD PC

  dba Fenton Wellness

  • Psychologist
  • Fenton, MI
  • NPI 1770859001

  Counselor

  Medicare reassignment Care Compare group NPD
• Fenton Wellness

  dba Jennifer Flack

  • Psychologist
  • Fenton, MI
  • NPI 1386964278

  Counselor

  NPD (past)

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

{
    "created_epoch": "1658361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1528793684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 N RIVER ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484303800",
            "telephone_number": "810-309-9355",
            "fax_number": "810-750-1152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 N RIVER ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484303800",
            "telephone_number": "810-309-9355",
            "fax_number": "810-750-1152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANNINO",
        "first_name": "JENNIFER",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-21",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401222784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PROFESSIONAL COUNSELOR",
            "identifier": "6401222784",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6401222784",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "staff@fentonwellness.com",
            "affiliation": "Y",
            "endpointDescription": "email",
            "affiliationName": "J Flack PsyD PC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "127 N River St",
            "city": "Fenton",
            "state": "MI",
            "country_code": "US",
            "postal_code": "484303800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kaelin Magrath, PA-C
• David Alan Mahan, BCHIS
• Hillary Margaret May Maier, LPC
• Jennifer E Malone
• Crystal D. Manney, LLMSW
• Heather F Mannor, P.A.-C
• Marshbanks Mental Health
• Beate L Martin, BSM
• James A Martin, MD
• Rita Maurais

• Professional Counselor in Fenton, MI
• Providers in Fenton, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.