Active NPI
Michelle Lynne Pettijohn, L.S.C.S.W.
- Clinical Social Worker
- Mission, KS
National Provider Identifier
1619110301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2213
- Practice address
- 5960 Dearborn St Ste 1
Mission, KS 66202-3342 - Phone
- (913) 645-6652
- NPI assigned
- Apr 11, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2213 | KS | Primary |
Addresses
Primary practice location
5960 Dearborn St Ste 1
Mission, KS 66202-3342
Mailing address
5960 Dearborn St Ste 1
Mission, KS 66202-3342
Phone (913) 645-6652
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 |
|---|---|---|---|
| 2213 | KS | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chautauqua Counseling Cener, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Mission, KS
- NPI 1841402203
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239408000000",
"number": "1619110301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5960 DEARBORN ST STE 1",
"city": "MISSION",
"state": "KS",
"postal_code": "662023342",
"telephone_number": "913-645-6652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5960 DEARBORN ST STE 1",
"city": "MISSION",
"state": "KS",
"postal_code": "662023342",
"telephone_number": "913-645-6652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIJOHN",
"first_name": "MICHELLE",
"middle_name": "LYNNE",
"name_prefix": "Mrs.",
"credential": "L.S.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-11",
"last_updated": "2009-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KS",
"license": "2213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mission, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.