KAITLYN SUE WIXSON — NPI 1629621925 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1629621925

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

101YP2500X (CMS E2)

Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor

Box 32 Service Location & ZIP+4

330 W MICHIGAN AVE, JACKSON, MI, 49201-2121

✓ 9-Digit EDI 837 ZIP+4 (49201-2121)

Practice Phone & Referral Fax

(517) 787-7920

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1629621925 (KAITLYN SUE WIXSON) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1629621925` (NPI-1 Individual Practitioner)
Provider / Legal Name	KAITLYN SUE WIXSON
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor NUCC Code: `101YP2500X` (Counselor, Professional)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	330 W MICHIGAN AVE, JACKSON, MI, 49201-2121
Practice Telephone / Fax	Tel: (517) 787-7920
Administrative Mailing Address	4914 CHURCHILL RD, LESLIE, MI, 49251-9794
Enumeration & Last Sync	Enumerated: 2019-07-17 \| CMS Record Updated: 2019-07-17

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

330 W MICHIGAN AVE, JACKSON, MI, 49201-2121

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Plain-English Taxonomy & CMS Crosswalk (101YP2500X)

What Does Taxonomy Code 101YP2500X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 101YP2500X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor"

CMS-1500 Medicare Specialty Crosswalk: CMS Code E2 (Licensed Professional Counselor)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Counselor, Professional for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (KAITLYN SUE WIXSON)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`101YP2500X` — Counselor, Professional Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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KAITLYN SUE WIXSON (NPI #1629621925)