Individual provider Active NPI

Nicole Phelps

  • Professional Counselor
  • Cleveland, OH
National Provider Identifier
1780179887
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
E.2102131 Issued in OH
Practice address
1744 Payne Ave
Cleveland, OH 44114-2910
Phone
(216) 623-6555
NPI assigned
Jun 30, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Professional Counselor 101YP2500X E.2102131 OH Primary

Addresses

Primary practice location

1744 Payne Ave
Cleveland, OH 44114-2910

Mailing address

1744 Payne Ave
Cleveland, OH 44114-2910
Phone (216) 623-6555

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240118002996 OH Practitioner - Mental Health Counselor 1254783897 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
E.2102131OHMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Mental Health Services for Homeless Persons, Inc. Multi-Specialty CurrentSince Jan 1, 2024 Accepting new patients

Locations

1744 Payne Ave
Cleveland, OH 44114
Phone (216) 361-8640

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1530316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1780179887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1744 PAYNE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441142910",
            "telephone_number": "216-623-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1744 PAYNE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441142910",
            "telephone_number": "216-623-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELPS",
        "first_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-30",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.2102131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.