NPIMap

Individual provider Active NPI

Tabatha Creasbaum, LMHC

  • Mental Health Counselor
  • Dyer, IN
National Provider Identifier
1972831568
Registry record updated Jan 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
39002363A Issued in IN
Practice address
630 Cottonwood Dr
Dyer, IN 46311-2207
Phone
(219) 588-3540
NPI assigned
Nov 19, 2009
Last updated
Jan 30, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2015

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 39002363A IN Primary

Addresses

Primary practice location

630 Cottonwood Dr
Dyer, IN 46311-2207

Mailing address

630 Cottonwood Dr
Dyer, IN 46311-2207
Phone (219) 588-3540

Other identifiers 1

IdentifierTypeStateIssuer
201207560AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
39002363AINMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Foundations Counseling Services, LLC Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1258588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422576000000",
    "number": "1972831568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 COTTONWOOD DR",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463112207",
            "telephone_number": "219-588-3540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 COTTONWOOD DR",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463112207",
            "telephone_number": "219-588-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREASBAUM",
        "first_name": "TABATHA",
        "name_prefix": "Ms.",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-19",
        "last_updated": "2015-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39002363A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201207560A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dyer, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2015; 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.