Justin M. Mickles, MS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4954 Issued in TN

Practice address

933 Tracy LN Ste D
Clarksville, TN 37040-6894

Phone

(931) 542-6637

NPI assigned

Sep 27, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Adaiah Biblical Counseling

  • Professional Counselor
  • Clarksville, TN
  • NPI 1780274704
  NPD Authorized official
• Homebase Counseling & Consulting, LLC

  • Mental Health Counselor
  • Omaha, NE
  • NPI 1154510394
  NPD (past) Authorized official
• Compass Family Health Clinic, PLLC

  • Family Medicine Physician
  • Clarksville, TN
  • NPI 1306496054
  NPD
• Imani Behavioral Health, PLLC

  • Psychologist
  • Clarksville, TN
  • NPI 1992294102
  NPD (past)

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1649266388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 FOX TRAIL CT",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370406251",
            "telephone_number": "615-853-1254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 TRACY LN STE D",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370406894",
            "telephone_number": "931-542-6637"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 N 35th St",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681114133",
            "country_code": "US",
            "telephone_number": "615-853-1254",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "695 Fox Trail Ct",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "370406251",
            "country_code": "US",
            "telephone_number": "615-853-1254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICKLES",
        "first_name": "JUSTIN",
        "middle_name": "M.",
        "name_prefix": "Mr.",
        "credential": "MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-27",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TN",
            "license": "4954",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NE",
            "license": "1485",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NE",
            "license": "57",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Meyer, FNP
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• Jocelyn Michael, BSW
• Stacey Michelin, FNP-C
• Mid Cumberland Infectious Disease Consultants PLC
• Middle Tennessee Imaging, LLC (Premier Radiology Clarksville)
• Middle Tennessee Imaging, LLC (Premier Radiology)
• Middle TN Home Health LLC. (ComForCare Home Care Clarksville)
• Crystal Middleton

• Professional Counselor in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Professional Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.