Jeffrey R Studebaker, LMHC, LCSW, LCAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

33002281A Issued in IN

Practice address

6202 Constitution Dr
Suite D
Fort Wayne, IN 46804-1583

Phone

(260) 432-0066

Fax

(260) 432-8503

NPI assigned

Mar 13, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Lifeworks Counseling & Consulting, Inc.

  • Professional Counselor
  • Fort Wayne, IN
  • NPI 1184886541
  NPD (past)

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

{
    "created_epoch": "1363132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363132800000",
    "number": "1588905715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6202 CONSTITUTION DR",
            "address_2": "SUITE D",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041583",
            "telephone_number": "260-432-0066",
            "fax_number": "260-432-8503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6202 CONSTITUTION DR",
            "address_2": "SUITE D",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041583",
            "telephone_number": "260-432-0066",
            "fax_number": "260-432-8503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUDEBAKER",
        "first_name": "JEFFREY",
        "middle_name": "R",
        "credential": "LMHC, LCSW, LCAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-13",
        "last_updated": "2013-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "87001434A",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39000242A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "33002281A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200912670A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Morgan Stuckey
• Paul Stuckey
• Roland Stuckey, MD
• Mitchell B Stucky, M.D.
• Valerie L Stucky, NP
• Kyla Study
• Jennifer Rebecca Stuff, NP
• Ronald J Stukey, D.O.
• Carol A Stults, NP
• Jeannie Stults, RBT, BS

• Clinical Social Worker in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; 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.