Individual provider Active NPI

Tom Walters, LMHC

  • Mental Health Counselor
  • South Bend, IN
National Provider Identifier
1871912774
Registry record updated Jul 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
39002588A Issued in IN
Practice address
415 E Madison St
South Bend, IN 46617-2322
Phone
(574) 533-1234
Fax
(574) 537-2652
NPI assigned
Apr 8, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 31, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 39002588A IN Primary

Addresses

Primary practice location

415 E Madison St
South Bend, IN 46617-2322

Mailing address

PO Box 809
Goshen, IN 46527-0809
Phone (574) 533-1234

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20240129000247 MA Practitioner - Mental Health Counselor 0941653703 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thrive Counseling LLCGroup PAC ID 0749458420, 1,187 clinicians

Practice addresses (Care Compare)

1 Emerson PL
Suite 3H
Boston, MA 02114-2252
Phone (855) 284-7483

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
39002588AINMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Counseling LLC Mental Health CurrentSince Jan 1, 2024 Accepting new patients

Locations

872 Massachusetts Ave
Ste 2-2
Cambridge, MA 02139
Phone 6173804651 ext. 1992

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1396915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406764800000",
    "number": "1871912774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 809",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465270809",
            "telephone_number": "574-533-1234",
            "fax_number": "574-537-2652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E MADISON ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172322",
            "telephone_number": "574-533-1234",
            "fax_number": "574-537-2652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "TOM",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-08",
        "last_updated": "2014-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39002588A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.