Individual provider Active NPI

Monica Burbank, LPCC-S

  • Professional Counselor
  • Moraine, OH
National Provider Identifier
1548780299
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
E.1901462-SUPV Issued in OH
Practice address
3095 Kettering Blvd
Moraine, OH 45439-1983
Phone
(937) 293-8300
NPI assigned
Jun 23, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X E.1901462-SUPV OH Primary
Counselor 101Y00000X C.1700265 OH

Addresses

Primary practice location

3095 Kettering Blvd
Moraine, OH 45439-1983

Mailing address

3095 Kettering Blvd
Moraine, OH 45439-1983
Phone (937) 293-8300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20240226001334 OH Practitioner - Mental Health Counselor 8628413044 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mindfully LLCGroup PAC ID 3476606252, 66 clinicians

Practice addresses (Care Compare)

10861 Yankee St
Dayton, OH 45458-3574
Phone (888) 830-0347

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C.1700265OHMDCounselor
E.1901462-SUPVOHMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Mindfully, LLC Counselor CurrentSince Jan 9, 2024 Accepting new patients
Mindfully, LLC Counselor CurrentSince Jan 9, 2024 Accepting new patients
Mindfully Psychiatry LLC Past Accepting new patients

Locations

199 S Chillicothe Rd
Ste 207
Aurora, OH 44202

5630 Bridgetown Rd
Ste 4
Cincinnati, OH 45248
Phone (513) 252-8054

8040 Hosbrook Rd
Ste 320
Cincinnati, OH 45236
Phone (513) 861-9797

100 E Campus View Blvd
Ste 250
Columbus, OH 43235
Phone (267) 817-8902

10861 Yankee St
Dayton, OH 45458
Phone (937) 619-0800

5050 Blazer Pkwy
Ste 101
Dublin, OH 43017
Phone (614) 451-7346

1251 Nilles Rd
Ste 5
Fairfield, OH 45014
Phone (732) 993-4599

6100 Oak Tree Blvd
Ste 200
Independence, OH 44131
Phone (330) 344-9030

1715 Indian Wood Cir
Ste 200
Maumee, OH 43537
Phone (216) 770-9367

10547 Montgomery Rd
Ste 700
Montgomery, OH 45242
Phone (513) 393-0300

110 S College Ave
Fl 2
Oxford, OH 45056
Phone (513) 273-0020

11565 Pearl Rd
Ste 200
Strongsville, OH 44136
Phone (440) 846-0862

3000 Regency Ct
Ste 207
Toledo, OH 43623
Phone (419) 471-0493

5900 W Chester Rd
Ste C
West Chester, OH 45069
Phone (513) 777-2428

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1498176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1548780299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3095 KETTERING BLVD",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391983",
            "telephone_number": "937-293-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3095 KETTERING BLVD",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391983",
            "telephone_number": "937-293-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURBANK",
        "first_name": "MONICA",
        "credential": "LPCC-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-23",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.1901462-SUPV",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "C.1700265",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moraine, OH

Sources for this page

Verify at the official NPI Registry.