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

Q: What is Melissa Jack's NPI number?

The NPI number for Melissa Jack is 1467974956. It was assigned to this individual provider in the NPPES registry on July 17, 2017.

Q: What is Melissa Jack's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Melissa Jack was last updated on November 18, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

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: August 16, 2026.

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

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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

Phone(317) 355-5009

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

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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

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.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.

TIFFANY L HATFIELD LCSW, LCAC-A

Social Worker (Clinical)