NPIMap

Organization Active NPI

Willowstone Family Services

  • Mental Health Counselor
  • Lafayette, IN
National Provider Identifier
1780742874
Registry record updated May 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
WILLOWSTONE FAMILY SERVICES
Practice address
615 N. 18TH St.
Suite 101
Lafayette, IN 47904-3434
Phone
(765) 423-5361
Fax
(765) 742-8272
NPI assigned
Dec 4, 2006
Last updated
May 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2024

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

Authorized official

Name
Mrs. Rebecca Sullivan, LCSWNPI 1740367291
Title
Ceo
Phone
(765) 423-5361

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

615 N. 18TH St.
Suite 101
Lafayette, IN 47904-3434

Mailing address

615 N. 18TH St.
Suite 101
Lafayette, IN 47904-3434
Phone (765) 423-5361

Other identifiers 2

IdentifierTypeStateIssuer
100445220AMedicaidIN
100264050MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070716000142 IN Part B Supplier - Clinic/Group Practice 0749234904 Receives reassigned benefits from 5 practitioners
Practice locations: Lafayette, IN

National Provider Directory

National Provider Directory
Tax ID family
Family Services Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

615 N 18th St
Ste 101
Lafayette, IN 47904
Phone (765) 423-5361

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714694400000",
    "number": "1780742874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N. 18TH ST.",
            "address_2": "SUITE 101",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479043434",
            "telephone_number": "765-423-5361",
            "fax_number": "765-742-8272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N. 18TH ST.",
            "address_2": "SUITE 101",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479043434",
            "telephone_number": "765-423-5361",
            "fax_number": "765-742-8272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWSTONE FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2024-05-03",
        "certification_date": "2024-05-03",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "765-423-5361",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100445220A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100264050",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.