MELISSA JACK LMHC
NPI 1467974956
Counselor - Mental Health in Indianapolis, IN

Active since July 17, 2017PECOS EnrolledAccepts Medicare Assignment
2040 N SHADELAND AVE STE 250, INDIANAPOLIS, IN 46219(317) 355-5009 Get Directions Write a Review

NPPES record last updated: November 18, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Nov 18, 2020, Sep 30, 2019, Jul 17, 2017 (3 updates tracked since 2017).

About Melissa Jack Lmhc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MELISSA JACK LMHC (NPI 1467974956) is an individual mental health provider in Indianapolis, Indiana, licensed in Indiana (39002394A) and active in the NPI registry since July 2017. She is enrolled in Medicare PECOS, maintains a secondary practice location in Indianapolis, and is a graduate of Other (2003).

NPPES Registry Identity

NPI1467974956
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameMELISSA JACKCredential: LMHC
Location Address2040 N SHADELAND AVE STE 250Indianapolis, IN 46219-1712
Mailing Address6626 E 75th St Ste 500Indianapolis, IN 46250-2890
Sole ProprietorNo
Medical School CMSOtherGraduated 2003
Enumeration DateJuly 17, 2017
Last NPPES UpdateNovember 18, 20203 updates tracked since enumeration
NPPES CertifiedNovember 18, 2020
NPI 1467974956 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License Licensed in IN · 39002394A
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 87000604A (IN)
2040 N SHADELAND AVE STE 250, Indianapolis, IN 46219

Secondary Practice Location 1

Location 1615 N Alabama St Ste 320Indianapolis, IN 46204-1432 · Phone (317) 634-6341 ext. 7984 · Fax (317) 464-9575

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Melissa Jack Lmhc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2860928686
PECOS Enrollment IDI20241204000209
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Counselor (Mental Health)
2040 N SHADELAND AVE STE 250
INDIANAPOLIS, IN 46219
Counselor (Mental Health)
2040 N SHADELAND AVE STE 250
INDIANAPOLIS, IN 46219
Social Worker (Clinical)
2040 N SHADELAND AVE STE 250
INDIANAPOLIS, IN 46219
Counselor (Mental Health)
2040 N SHADELAND AVE STE 250
INDIANAPOLIS, IN 46219
Nurse Practitioner (Psychiatric/Mental Health)
2040 N SHADELAND AVE STE 250
INDIANAPOLIS, IN 46219
Social Worker (Clinical)
2040 N SHADELAND AVE STE 250
INDIANAPOLIS, IN 46219
Social Worker (Clinical)
2040 N SHADELAND AVE STE 250
INDIANAPOLIS, IN 46219
Social Worker (Clinical)
2040 N SHADELAND AVE STE 250
INDIANAPOLIS, IN 46219

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1467974956, enumerated as an "individual" on July 17, 2017.

The provider is located at 2040 N SHADELAND AVE STE 250 INDIANAPOLIS, IN 46219 and the phone number is (317) 355-5009.

Counselor with taxonomy code 101YM0800X and a focus in Mental Health.

The provider might be accepting Accepts: Ambetter from Buckeye Health Plan, Ambetter from. Please consult your insurance carrier or call the provider to verify.