Michael W. Nettles

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LC4560 Issued in MD

Practice address

1858 Rochelle Ave
Capitol Heights, MD 20743-4306

Phone

(202) 247-1999

Fax

(301) 513-0181

NPI assigned

Aug 17, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mr. Michael W. Nettles Former name

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: No
• 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.

• Mbi Health Services LLC

  • Community/Behavioral Health Agency
  • Washington, DC
  • NPI 1396048070
  Medicare reassignment NPD

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

{
    "created_epoch": "1345161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345161600000",
    "number": "1962750257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5206 MINEOLA RD",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207404612",
            "telephone_number": "202-247-1999",
            "fax_number": "301-513-0181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1858 ROCHELLE AVE",
            "city": "CAPITOL HEIGHTS",
            "state": "MD",
            "postal_code": "207434306",
            "telephone_number": "202-247-1999",
            "fax_number": "301-513-0181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETTLES",
        "first_name": "MICHAEL",
        "middle_name": "W.",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-17",
        "last_updated": "2012-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC4560",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "DC",
            "license": "PRC14104",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAEL",
            "last_name": "NETTLES",
            "middle_name": "W.",
            "prefix": "MR.",
            "credential": "LPC/LCPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Professional Counselor in Capitol Heights, MD
• Providers in Capitol Heights, MD by specialty
• Professional Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2012; 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.