Active NPI
Kryston Jean Noble-Hartzler, LCSW, LCAC
- Clinical Social Worker
- Goshen, IN
National Provider Identifier
1992084131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34005513A
- Practice address
- 114 S Main St
Goshen, IN 46526-3702 - Phone
- (574) 533-6154
- Fax
- (574) 534-3951
- NPI assigned
- Aug 5, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 87000436A | IN | |
| Clinical Social Worker | 1041C0700X | 6801091039 | MI | |
| Clinical Social Worker | 1041C0700X | 34005513A | IN | Primary |
Addresses
Primary practice location
114 S Main St
Goshen, IN 46526-3702
Mailing address
114 S Main St
Goshen, IN 46526-3702
Phone (574) 533-6154
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 87000436A | IN | MD | Addiction (Substance Use Disorder) Counselor |
| 34005513A | IN | MD | Clinical Social Worker |
| 6801091039 | MI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Addiction Recovery Centers of Indiana, Incorporated | 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 and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Goshen, IN
- NPI 1467689406
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312502400000",
"number": "1992084131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 S MAIN ST",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465263702",
"telephone_number": "574-533-6154",
"fax_number": "574-534-3951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 S MAIN ST",
"city": "GOSHEN",
"state": "IN",
"postal_code": "465263702",
"telephone_number": "574-533-6154",
"fax_number": "574-534-3951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOBLE-HARTZLER",
"first_name": "KRYSTON",
"middle_name": "JEAN",
"name_prefix": "Ms.",
"credential": "LCSW, LCAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-05",
"last_updated": "2011-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IN",
"license": "87000436A",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801091039",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34005513A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goshen, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.