Individual provider Active NPI

Samantha D'Esti Eisenhart-Petkovski, LMHC, LPC

  • Professional Counselor
  • South Lyon, MI
National Provider Identifier
1629293261
Registry record updated Feb 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
77807 Issued in TX
Practice address
60657 S Lyon TRL
South Lyon, MI 48178-9054
Phone
(321) 356-0146
NPI assigned
Apr 17, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH8108 FL
Professional Counselor 101YP2500X 6401011614 MI
Professional Counselor 101YP2500X 77807 TX Primary

Addresses

Primary practice location

60657 S Lyon TRL
South Lyon, MI 48178-9054

Mailing address

204 Eagle CT
Bedford, TX 76021-3216
Phone (972) 895-2326

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

LicenseStateTypeSpecialty
MH8108FLMDMental Health Counselor
6401011614MIMDProfessional Counselor
77807TXMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
McPherson Counseling, PLLC Professional 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.

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1629293261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 EAGLE CT",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760213216",
            "telephone_number": "972-895-2326",
            "fax_number": "866-627-3513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60657 S LYON TRL",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481789054",
            "telephone_number": "321-356-0146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISENHART-PETKOVSKI",
        "first_name": "SAMANTHA",
        "middle_name": "D'ESTI",
        "name_prefix": "Mrs.",
        "credential": "LMHC, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH8108",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401011614",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "77807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Lyon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2025; 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.