NPIMap

Organization Active NPI

Life Transitions Counseling Center, LLC

  • Counseling Psychologist
  • Fort Wayne, IN
National Provider Identifier
1912356783
Registry record updated Jun 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
20042044A Issued in IN
Legal business name
LIFE TRANSITIONS COUNSELING CENTER, LLC
Practice address
4630 W Jefferson Blvd
#11A
Fort Wayne, IN 46804-6856
Phone
(260) 434-1606
Fax
(260) 434-1606
NPI assigned
Jun 12, 2016
Last updated
Jun 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2016

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

Authorized official

Name
Dr. Michelle Renee Miller, PH.D.NPI 1003929456
Title
Psychologist/Owner
Phone
(260) 434-1606

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X 20042044A IN Primary

Addresses

Primary practice location

4630 W Jefferson Blvd
#11A
Fort Wayne, IN 46804-6856

Mailing address

4630 W Jefferson Blvd
#11A
Fort Wayne, IN 46804-6856
Phone (260) 434-1606

National Provider Directory

National Provider Directory

Locations

4630 W Jefferson Blvd
Ste 11A
Fort Wayne, IN 46804
Phone (260) 434-1606

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1465689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465689600000",
    "number": "1912356783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4630 W JEFFERSON BLVD",
            "address_2": "#11A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046856",
            "telephone_number": "260-434-1606",
            "fax_number": "260-434-1606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4630 W JEFFERSON BLVD",
            "address_2": "#11A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046856",
            "telephone_number": "260-434-1606",
            "fax_number": "260-434-1606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE TRANSITIONS COUNSELING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-12",
        "last_updated": "2016-06-12",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "260-434-1606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "IN",
            "license": "20042044A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.