Lydia Carissa Pongo, LLPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401016718 Issued in MI

Practice address

830 Pleasant St
Saint Joseph, MI 49085-1102

Phone

(269) 982-3832

NPI assigned

Jul 13, 2018

Last updated

Jul 13, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Therapy & Development Centers Inc

  • Mental Health Counselor
  • Saint Joseph, MI
  • NPI 1295916187
  NPD (past)

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

{
    "created_epoch": "1531440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531440000000",
    "number": "1942786868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4384 LAUREL DR",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859311",
            "telephone_number": "269-982-3832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 PLEASANT ST",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851102",
            "telephone_number": "269-982-3832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONGO",
        "first_name": "LYDIA",
        "middle_name": "CARISSA",
        "credential": "LLPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-13",
        "last_updated": "2018-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401016718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia A Pierce, CSW
• McKenna Pilley
• Gabrielle Pine, DO
• Nathan E Piovesan, MD
• Stanley W Pletcher, M.D.
• Joseph Popa
• Jeanette O'Neill Postelli, NP
• Thomas K Pow, M.D.
• Powell House Afc
• Melissa Powell

• Professional Counselor in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2018; 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.