NPIMap

Individual provider Active NPI

Mimi M Kennedy-Ross, LPC

  • Professional Counselor
  • Oracle, AZ
National Provider Identifier
1760927412
Registry record updated Jan 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC-16413 Issued in AZ
Practice address
Dodge & Mt Lemmon Rd
Oracle, AZ 85623
Phone
(520) 896-9240
NPI assigned
Jan 4, 2017
Last updated
Jan 4, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 4, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC-16413 AZ Primary

Addresses

Primary practice location

Dodge & Mt Lemmon Rd
Oracle, AZ 85623

Mailing address

Dodge & Mt Lemmon Rd
Oracle, AZ 85623
Phone (520) 896-9240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LPC-16413AZMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Marana Health Center, Inc Past Accepting new patients
Horizon Health & Wellness, Inc. Past Accepting new patients
Horizon Health and Wellness, Inc. Past Accepting new patients
Florence Unified School District #1 Past Accepting new patients
Horizon Health and Wellness, Inc. Past Accepting new patients
Florence Unified School District PastSince Oct 19, 2020 Accepting new patients

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1483488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483488000000",
    "number": "1760927412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DODGE & MT LEMMON RD",
            "city": "ORACLE",
            "state": "AZ",
            "postal_code": "85623",
            "telephone_number": "520-896-9240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DODGE & MT LEMMON RD",
            "city": "ORACLE",
            "state": "AZ",
            "postal_code": "85623",
            "telephone_number": "520-896-9240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY-ROSS",
        "first_name": "MIMI",
        "middle_name": "M",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-04",
        "last_updated": "2017-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LPC-16413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oracle, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; 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.