1083788426 NPI number — LINCOLN COUNSELING, PC

Table of content: (NPI 1083788426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083788426 NPI number — LINCOLN COUNSELING, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN COUNSELING, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083788426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 W COLFAX AVE STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BEND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46601-1635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-255-4976
Provider Business Mailing Address Fax Number:
574-255-1882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 W COLFAX AVE STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46601-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-255-4976
Provider Business Practice Location Address Fax Number:
574-255-1882
Provider Enumeration Date:
11/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CURTIS
Authorized Official First Name:
JEANNINE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
574-255-4976

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  68000016A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 68000016A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 68000016A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 68000016A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: 680000016A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 680000016A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 68000016A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000341216 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200475040B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200021670 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 740606000 . This is a "MAGELLAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200475040A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 399077 . This is a "MHN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 7014575 . This is a "AETNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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