Nicole Darlene Ethridge, MA, LPC in Columbia, MO

Nicole Darlene Ethridge, MA, LPC is a medicare enrolled "Counselor - Professional" provider in Columbia, Missouri. Her current practice location is 1805 E Walnut St, Columbia, Missouri. You can reach out to her office (for appointments etc.) via phone at (573) 777-7500.

Nicole Darlene Ethridge is licensed to practice in California (license number 16030) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1760974596.

Contact Information

	Nicole Darlene Ethridge, MA, LPC
	1805 E Walnut St, Columbia, MO 65201-6425
	(573) 777-7500
	(573) 777-7505

Map and Direction

Healthcare Provider's Profile

Full Name	Nicole Darlene Ethridge
Gender	Female
Speciality	Counselor - Professional
Location	1805 E Walnut St, Columbia, Missouri
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1760974596
Provider Enumeration Date: 06/06/2018
Last Update Date: 10/01/2024

Medicare PECOS Information:

PECOS PAC ID: 6507214608
Enrollment ID: I20231130000760

Medical Identifiers

Medical identifiers for Nicole Darlene Ethridge such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1760974596	NPI	-	NPPES
490055189	Medicaid	MO

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
101YP2500X	Counselor - Professional	16030 (California)	Primary
101Y00000X	Counselor	2018013675 (Missouri)	Secondary
101YP2500X	Counselor - Professional	37PC00899200 (New Jersey)	Secondary
101YP2500X	Counselor - Professional	PC-0011186 (Delaware)	Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Nicole Darlene Ethridge allows following entities to bill medicare on her behalf.

Entity Name	Burrell, Inc.
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1275541740 PECOS PAC ID: 4486548625 Enrollment ID: O20040210000372

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Nicole Darlene Ethridge is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Nicole Darlene Ethridge, MA, LPC 1300 E Bradford Pkwy, Springfield, MO 65804-4264 Ph: (417) 761-5000	Nicole Darlene Ethridge, MA, LPC 1805 E Walnut St, Columbia, MO 65201-6425 Ph: (573) 777-7500

Reviews and Comments

Counselor in Columbia, MO

Mr. Gregory Len Boyt, M.A., L.P.C. Counselor Medicare: Not Enrolled in Medicare Practice Location: 117 N Garth Ave, Columbia, MO 65203 Phone: 573-673-7381 Fax: 573-875-8089
Lindsay K Ingram, PLPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 200 Portland St, Columbia, MO 65201 Phone: 844-853-8937
Elizabeth Catherine Whittom, Counselor Medicare: Not Enrolled in Medicare Practice Location: 201 W Broadway Ste 2f, Columbia, MO 65203 Phone: 573-214-0436
Mr. Robert Alan Rucker, Counselor Medicare: Not Enrolled in Medicare Practice Location: 800 Hospital Dr, Columbia, MO 65201 Phone: 619-507-6911
Renee Powers-scott, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 3309 Lance Dr, Columbia, MO 65202 Phone: 573-999-6537
Jared Torbet, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 2600 Forum Blvd Ste G, Columbia, MO 65203 Phone: 573-239-9915 Fax: 573-340-1028
Amy Michelle Evans, Counselor Medicare: Not Enrolled in Medicare Practice Location: 4304 S Bearfield Rd, Columbia, MO 65201 Phone: 573-874-8686

Nicole Darlene Ethridge, MA, LPC - Medicare Counselor in Columbia, MO