Active NPI
Jada Rosemary Mutic, LPC
- Mental Health Counselor
- Creve Coeur, MO
National Provider Identifier
1811234172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2010021555
- Practice address
- 11207 Mosley Hill Dr
Creve Coeur, MO 63141-7622 - Phone
- (314) 993-3481
- NPI assigned
- Jan 7, 2013
- 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 | 2010021555 | MO | Primary |
Addresses
Primary practice location
11207 Mosley Hill Dr
Creve Coeur, MO 63141-7622
Mailing address
11207 Mosley Hill Drive
Creve Coeur, MO 63141
Phone (314) 993-3481
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2010021555 | MO | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357516800000",
"number": "1811234172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11207 MOSLEY HILL DRIVE",
"city": "CREVE COEUR",
"state": "MO",
"postal_code": "63141",
"telephone_number": "314-993-3481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11207 MOSLEY HILL DR",
"city": "CREVE COEUR",
"state": "MO",
"postal_code": "631417622",
"telephone_number": "314-993-3481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUTIC",
"first_name": "JADA",
"middle_name": "ROSEMARY",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-01-07",
"last_updated": "2013-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MO",
"license": "2010021555",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Creve Coeur, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.