Brock Owen Bodenbender, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

E.2001912 Issued in OH

Practice address

17951 Jefferson Park Rd Ste 100
Middleburg Heights, OH 44130-8439

Phone

(440) 879-8517

NPI assigned

Apr 19, 2017

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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, 2018

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Transformation Wellness LLCGroup PAC ID 2062889611, 9 clinicians

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Burl Ring Counseling, Construction & Consulting LLC

  • Mental Health Counselor
  • Madison, OH
  • NPI 1780531012
  Medicare reassignment NPD Authorized official
• Transformation Wellness LLC

  dba Stella Luna Counseling and Wellness

  • Mental Health Counselor
  • Middleburg Heights, OH
  • NPI 1033854658
  Medicare reassignment Care Compare group NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  OH

  Medicare reassignment NPD

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1750815452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17951 JEFFERSON PARK RD STE 100",
            "city": "MIDDLEBURG HEIGHTS",
            "state": "OH",
            "postal_code": "441308439",
            "telephone_number": "440-879-8517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17951 JEFFERSON PARK RD STE 100",
            "city": "MIDDLEBURG HEIGHTS",
            "state": "OH",
            "postal_code": "441308439",
            "telephone_number": "440-879-8517"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12557 Ravenwood Dr",
            "address_purpose": "LOCATION",
            "city": "Chardon",
            "state": "OH",
            "postal_code": "440249009",
            "country_code": "US",
            "telephone_number": "440-285-3568",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18660 Bagley Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Middleburg Heights",
            "state": "OH",
            "postal_code": "441303483",
            "country_code": "US",
            "telephone_number": "440-879-8517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BODENBENDER",
        "first_name": "BROCK",
        "middle_name": "OWEN",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-19",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.2001912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0267340",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Eugene Bondar

• Mental Health Counselor in Middleburg Heights, OH
• Providers in Middleburg Heights, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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.