Active NPI
Lisa A Ianitelli, MA, LLPC
- Mental Health Counselor
- Centerville, MI
National Provider Identifier
1801249974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6401015504
- Practice address
- 658 E. Main St
Centerville, MI 49032 - Phone
- (269) 467-9045
- NPI assigned
- Jul 13, 2016
- Last updated
- Aug 11, 2023
- Sex
- Female
- 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 | 6401015504 | MI | Primary |
Addresses
Primary practice location
658 E. Main St
Centerville, MI 49032
Mailing address
658 E. Main St
Centerville, MI 49032
Phone (269) 467-9045
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401015504 | MI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691712000000",
"number": "1801249974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "658 E. MAIN ST",
"city": "CENTERVILLE",
"state": "MI",
"postal_code": "49032",
"telephone_number": "269-467-9045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "658 E. MAIN ST",
"city": "CENTERVILLE",
"state": "MI",
"postal_code": "49032",
"telephone_number": "269-467-9045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IANITELLI",
"first_name": "LISA",
"middle_name": "A",
"name_prefix": "Mrs.",
"credential": "MA, LLPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-13",
"last_updated": "2023-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MI",
"license": "6401015504",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.