Individual provider Active NPI

Marissa Lynn Lindberg, LPCC

  • Professional Counselor
  • Canton, OH
National Provider Identifier
1922656396
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
E.2202953 Issued in OH
Practice address
1341 Market Ave N
Canton, OH 44714-2605
Phone
(330) 455-0374
Fax
(330) 453-6716
NPI assigned
Aug 29, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X E.2202953 OH Primary

Addresses

Primary practice location

1341 Market Ave N
Canton, OH 44714-2605

Mailing address

625 Cleveland Ave NW
Canton, OH 44702-1805
Phone (330) 455-0374

Other identifiers 1

IdentifierTypeStateIssuer
0367245MedicaidOH

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20231130002431 OH Practitioner - Mental Health Counselor 4082062013 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Commquest Services, Inc.Group PAC ID 9335110824, 22 clinicians

Practice addresses (Care Compare)

601 Cleveland Ave NW
Canton, OH 44702-1836
Phone (330) 453-8252

625 Cleveland Ave NW
Canton, OH 44702-1805
Phone (330) 455-0374

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
E.2202953OHMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Commquest Services, Inc. Addiction (Substance Use Disorder) CurrentSince Jan 1, 2024 Accepting new patients
Commquest Services, Inc. Addiction (Substance Use Disorder) CurrentSince Jan 1, 2024 Accepting new patients

Locations

601 Cleveland Ave NW
Canton, OH 44702
Phone (330) 453-8252

625 Cleveland Ave NW
Canton, OH 44702
Phone (330) 445-2677

1341 Market Ave N
Canton, OH 44714
Phone (330) 453-8252

130 1st St NW
Massillon, OH 44647
Phone (330) 833-0234

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 2

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": "1567036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1922656396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 CLEVELAND AVE NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447021805",
            "telephone_number": "330-455-0374",
            "fax_number": "330-453-6716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1341 MARKET AVE N",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447142605",
            "telephone_number": "330-455-0374",
            "fax_number": "330-453-6716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LINDBERG",
        "first_name": "MARISSA",
        "middle_name": "LYNN",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-29",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.2202953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0367245",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.