Active NPI
Heath K. Lisenby, DMIN., LMHC
- Mental Health Counselor
- Fort Wayne, IN
National Provider Identifier
1730289810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 39001625A
- Practice address
- 6322 Constitution Dr
Fort Wayne, IN 46804-1518 - Phone
- (260) 203-0294
- Fax
- (260) 264-4581
- NPI assigned
- Sep 25, 2006
- Last updated
- Apr 22, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 39001625A | IN | Primary |
Addresses
Primary practice location
6322 Constitution Dr
Fort Wayne, IN 46804-1518
Mailing address
6322 Constitution Dr
Fort Wayne, IN 46804-1518
Phone (260) 203-0294
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 29, 2024 through Jan 29, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39001625A | IN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650585600000",
"number": "1730289810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6322 CONSTITUTION DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468041518",
"telephone_number": "260-203-0294",
"fax_number": "260-264-4581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6322 CONSTITUTION DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468041518",
"telephone_number": "260-203-0294",
"fax_number": "260-264-4581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LISENBY",
"first_name": "HEATH",
"middle_name": "K.",
"name_prefix": "Dr.",
"credential": "DMIN., LMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2022-04-22",
"certification_date": "2022-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "39001625A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.