Active NPI
Melissa Collingsworth, MSW, LCSW
- Counselor
- Fort Wayne, IN
National Provider Identifier
1588061592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 909 E State Blvd
Fort Wayne, IN 46805-3404 - Phone
- (260) 481-2700
- Fax
- (260) 481-2709
- NPI assigned
- Nov 20, 2014
- Last updated
- Sep 13, 2021
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary | ||
| Social Worker | 104100000X | 33007721A | IN | |
| Clinical Social Worker | 1041C0700X | 34009112A | IN |
Addresses
Primary practice location
909 E State Blvd
Fort Wayne, IN 46805-3404
Mailing address
5904 E State Blvd
Fort Wayne, IN 46815-7637
Phone (260) 203-9185
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34009112A | Other | IN | INDIANA BEHAVIORAL HEALTH BOARD |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | melissa.collingsworth@pathways.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33007721A | IN | MD | Social Worker |
| 34009112A | IN | MD | Clinical Social Worker |
Interoperability endpoints
- melissa.collingsworth@pathways.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631491200000",
"number": "1588061592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5904 E STATE BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468157637",
"telephone_number": "260-203-9185",
"fax_number": "260-203-9187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "909 E STATE BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468053404",
"telephone_number": "260-481-2700",
"fax_number": "260-481-2709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLINGSWORTH",
"first_name": "MELISSA",
"credential": "MSW, LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-20",
"last_updated": "2021-09-13",
"certification_date": "2021-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IN",
"license": "33007721A",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34009112A",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIANA BEHAVIORAL HEALTH BOARD",
"identifier": "34009112A",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "melissa.collingsworth@pathways.com",
"affiliation": "N",
"address_1": "5904 E State Blvd",
"city": "Fort Wayne",
"state": "IN",
"country_code": "US",
"postal_code": "468157637",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.