Mindy Mack

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C1100298 Issued in OH

Practice address

335 Buckeye Blvd
Port Clinton, OH 43452-1423

Phone

(419) 734-2942

Fax

(419) 734-4922

NPI assigned

Oct 17, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Firelands Regional Medical Center

  • General Acute Care Hospital
  • Sandusky, OH
  • NPI 1801884655
  Medicare reassignment NPD

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413504000000",
    "number": "1861896953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 HAYES AVE",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704737",
            "telephone_number": "419-557-7400",
            "fax_number": "419-557-6219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 BUCKEYE BLVD",
            "city": "PORT CLINTON",
            "state": "OH",
            "postal_code": "434521423",
            "telephone_number": "419-734-2942",
            "fax_number": "419-734-4922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "MINDY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-17",
        "last_updated": "2014-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C1100298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Light House Sober Living
• Debra S Lowe, DMD
• Erin Lucas
• Olivia Luppino
• Kris Lyons
• Madison Eye Care of Port Clinton LLC
• Magruder Medical Group LTD
• Anissa Natalia Mahmood, M.S., P.C.
• Lisa Maletich
• Olga Marez

• Mental Health Counselor in Port Clinton, OH
• Providers in Port Clinton, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.