Michael Thackery

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

8875 Issued in SC

Practice address

1495 Remount Rd Ste 3a
North Charleston, SC 29406-3320

Phone

(843) 882-6880

NPI assigned

Jan 15, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

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

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Breathe Life Counseling

  • Mental Health Counselor
  • North Charleston, SC
  • NPI 1649927492
  Medicare reassignment NPD

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

{
    "created_epoch": "1736899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1659182004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1495 REMOUNT RD STE 3A",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294063320",
            "telephone_number": "843-882-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1495 REMOUNT RD STE 3A",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294063320",
            "telephone_number": "843-882-6880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKERY",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-15",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "SC",
            "license": "8875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mike@breathelifecounseling.com",
            "affiliation": "Y",
            "endpointDescription": "Email",
            "affiliationName": "Breathe Life Counseling",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "1495 Remount Rd Ste 3A",
            "city": "North Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294063320",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bradley Richard Teasley, DO
• Julie Siman Teiken, PT MSR
• Mollie S Temple, SLP
• William A Terranova, MD
• Ryan E Terrell, LPC
• Katelin Rose Thames, MA, LPC, LMHC
• Angela Christine Tharnish, D.C.
• Allyson J Thatcher, MD
• The Affective Collective LLC
• The Breast Place LLC

• Mental Health Counselor in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Mental Health Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.