Active NPI
Jacob Clinebell, M.A.
- Mental Health Counselor
- Wilkes Barre, PA
National Provider Identifier
1841602414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- PC010455
- Practice address
- 1111 E End Blvd
Wilkes Barre, PA 18711-0030 - Phone
- (570) 824-3521
- NPI assigned
- May 29, 2014
- Last updated
- May 29, 2024
- Sex
- Male
- Sole proprietor
- No
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 | PC010455 | PA | Primary |
Addresses
Primary practice location
1111 E End Blvd
Wilkes Barre, PA 18711-0030
Mailing address
1111 E End Blvd
Wilkes Barre, PA 18711-0030
Phone (570) 824-3520
Other practice location 1
500 N Bridge St
Bridgewater, NJ 08807-2135
Phone (908) 725-2800 ext. 3049
Other practice location 2
5300 Kidspeace Dr
Orefield, PA 18069-2044
Phone (610) 799-8910 ext. 5
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326173360 | Medicaid | PA | |
| PC010455 | Other | PA | PENNSYLVANIA STATE LICENSED PROFESSIONAL COUNSELOR LICENSE |
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 |
|---|---|---|---|
| PC010455 | PA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716940800000",
"number": "1841602414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 E END BLVD",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "187110030",
"telephone_number": "570-824-3520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 E END BLVD",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "187110030",
"telephone_number": "570-824-3521"
}
],
"practiceLocations": [
{
"address_1": "500 N Bridge St",
"address_purpose": "LOCATION",
"city": "Bridgewater",
"state": "NJ",
"postal_code": "088072135",
"country_code": "US",
"telephone_number": "908-725-2800 x3049",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5300 Kidspeace Dr",
"address_purpose": "LOCATION",
"city": "Orefield",
"state": "PA",
"postal_code": "180692044",
"country_code": "US",
"telephone_number": "610-799-8910 x5",
"fax_number": "610-776-1694",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CLINEBELL",
"first_name": "JACOB",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-05-29",
"last_updated": "2024-05-29",
"certification_date": "2024-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "PA",
"license": "PC010455",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1326173360",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PENNSYLVANIA STATE LICENSED PROFESSIONAL COUNSELOR LICENSE",
"identifier": "PC010455",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilkes Barre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.