Unknown Individual – Mental Health Counselor, NPI 1063689768

Unknown Individual is a healthcare provider. based in Logansport, Indiana. specializing in Mental Health Counselor. The NPI Number for Unknown Individual is 1063689768

Main info

Organization
Inactive
17 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1063689768
Phone
(574) 732-1414
Address
1807 SMITH ST
Deactivation Date
11 June 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7654232638
Graduation Year
2009 (17 years ago)
PAC ID
0840462487
Group Practice PAC ID
7315927563
Professional Enrollment ID
I20111004000477
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience5
Completeness75
Years active:0State licenses:0Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1807, Smith Street, Logansport, Cass County, Indiana, 46947, United States

    LOGANSPORT, IN 469471576

    Phone: (574) 732-1414

    Fax: (574) 732-0504

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 46947)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7315927563View full group profile
NameSpecialtyState
-IN
Clinical Social WorkerIN
Marriage And Family TherapistIN
Nurse PractitionerIN
Nurse PractitionerIN
-IN
P S Y C H I A T R YIN
-IN
Clinical Social WorkerIN
Nurse PractitionerIN

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1063689768 on file in the registry.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Mental Health Counselor. Clinical services aligned with this taxonomy classification.
Where in Indiana is Unknown Individual registered?
Use Logansport, Indiana as the headline location for Unknown Individual here.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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