Individual provider Active NPI

Anna Holbrook, LMHC

  • Mental Health Counselor
  • Fort Wayne, IN
National Provider Identifier
1629865985
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
39005388A Issued in IN
Practice address
636 Lillian Ave
Fort Wayne, IN 46808-2112
Phone
(574) 349-7901
NPI assigned
Apr 21, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 39005388A IN Primary

Addresses

Primary practice location

636 Lillian Ave
Fort Wayne, IN 46808-2112

Mailing address

636 Lillian Ave
Fort Wayne, IN 46808-2112
Phone (574) 349-7901

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20251113000756 IN Practitioner - Mental Health Counselor 4486145844 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

11109 Parkview Plaza Dr
Suite 117
Fort Wayne, IN 46845-1701

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
39005388AINMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Park Center Inc CurrentSince Sep 7, 2025 Accepting new patients
Park Center Inc CurrentSince Sep 7, 2025 Accepting new patients

Locations

909 E State Blvd
Fort Wayne, IN 46805
Phone (260) 481-2718

Organizations & group practices 2

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": "1745193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747872000000",
    "number": "1629865985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 LILLIAN AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468082112",
            "telephone_number": "574-349-7901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 LILLIAN AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468082112",
            "telephone_number": "574-349-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLBROOK",
        "first_name": "ANNA",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-21",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39005388A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.