MS. JEANETTE L BROYLES (NPI# 1780745380) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780745380 |
| Entity Type | Individual |
| Full Name | MS. JEANETTE L BROYLES |
| Credential | LPC |
| Practice Address |
100 Professional Park Ste 302 Carrollton GA 30117-3872 |
| Practice Telephone | 7708301300 |
| Practice Fax Number | 7708345469 |
| Mailing Telephone | 7708301300 |
| Mailing Fax Number | 7708345469 |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | LPC 3427 | GA | Behavioral Health & Social Service Providers |
| Street Address |
100 PROFESSIONAL PARK STE 302 |
| City | CARROLLTON |
| State | GA |
| Zip Code | 30117-3872 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932190535 | Joseph Jellicorse | Family Medicine | 100 Professional Park, Suite 204, Carrollton, GA 30117-3874 | 2005-11-02 |
| 1932409166 | Keri L Minton | Physician Assistant | 100 Professional Park, Suite 310, Carrollton, GA 30117-3874 | 2010-10-21 |
| 1962653386 | Holley V. Hagan | Nurse Practitioner | 100 Professional Park, Suite 202, Carrollton, GA 30117 | 2008-10-03 |
| 1154473627 | Shawn R Skalin | Counselor | 100 Professional Park, Suite 302, Carrollton, GA 30117 | 2007-01-17 |
| 1003834557 | Michael Anthony Poss | Family Medicine | 100 Professional Park, Suite 202, Carrollton, GA 30117 | 2006-07-17 |
| 1346268810 | Charles Hoyt Davis IIi | Family Medicine | 100 Professional Park, Suite 202, Carrollton, GA 30117-3802 | 2006-07-17 |
| 1639104748 | Jeffrey S. Reid | Internal Medicine | 100 Professional Park, Suite 204, Carrollton, GA 30117-3874 | 2006-07-11 |
| 1205876000 | Lakshmana D Surapu | Psychologist | 100 Professional Park, Suite 301, Carrollton, GA 30117 | 2006-06-08 |
| 1205874468 | Alexander Meski | Psychologist | 100 Professional Park, Suite 301, Carrollton, GA 30117 | 2006-06-02 |
| 1467404871 | Lindsey Baskin Roenigk | Internal Medicine | 100 Professional Park, Suite 204, Carrollton, GA 30117-3874 | 2006-05-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679199392 | Southern Rad Onc LLC | Radiology | 809 South Park Street, Carrollton, GA 30117 | 2020-06-18 |
| 1093361404 | Eyedeal Eyecare LLC | Optometrist | 1735 S Us 27, Carrollton, GA 30117 | 2019-08-12 |
| 1710412473 | Janis James | Optometrist | 1735 S, Us-27, Walmart Vision Center, Carrollton, GA 30117 | 2017-05-01 |
| 1568881951 | Omar Hajmurad | Anesthesiology | 812 S Park St Ste 5, Carrollton, GA 30117 | 2014-04-14 |
| 1134550353 | Goodbodys Minor Med Express Care | Nurse Practitioner | 1670 South Park St., Carrollton, GA 30117 | 2013-12-13 |
| 1306187570 | Myriam C Vela-ortiz | Internal Medicine | 157 Clinic Ave Ste 203, Carrollton, GA 30117 | 2013-03-12 |
| 1891030201 | Air Evac Ems, Inc. | Ambulance | 827 Old Bremen Rd, Carrollton, GA 30117 | 2012-12-11 |
| 1952682486 | Angelic Wings Transport, Inc. | Non-emergency Medical Transport (VAN) | 362 B Columbia Drive, Carrollton, GA 30117 | 2011-08-29 |
| 1073819256 | Atlanta Prosthetics & Orthotics, Inc. | Durable Medical Equipment & Medical Supplies | 812 South Park Street, Suite 2, Carrollton, GA 30117 | 2011-02-04 |
| 1255640348 | Amy Gilbert | Counselor | 515 Tanner St, Carrollton, GA 30117 | 2010-10-06 |
| Find all providers in zip 30117 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477152809 | Wellovation LLC | Counselor | 1220 W Trinity Mills Rd, Carrollton, TX 75006-1303 | 2020-10-16 |
| 1083234678 | Faith Johnson | Counselor | 139 Newnan Rd, Carrollton, GA 30117-3442 | 2020-04-23 |
| 1104454016 | Karmen Kay Scott | Counselor | 20396 Cr 240, Carrollton, MO 64633-8151 | 2020-03-28 |
| 1396375341 | Princy Sebastian | Counselor | 4408 Emerald Dr, Carrollton, TX 75010-4514 | 2020-01-17 |
| 1528601010 | Tessa Isom | Counselor | 245 Second St Sw, Carrollton, OH 44615-1305 | 2019-10-28 |
| 1538713425 | Latoya Banton | Counselor | 85 Tyus Carrollton Rd, Carrollton, GA 30117-8254 | 2019-07-29 |
| 1053899757 | Ana Lyllian Guadalupe Menjivar-couch | Counselor | 840 Lake Connie Rd, Carrollton, GA 30116-9783 | 2018-08-03 |
| 1669992061 | Vanessa Fajardo | Counselor | 1925 E Belt Line Rd Ste 258, Carrollton, TX 75006-5801 | 2017-06-27 |
| 1710422936 | Sharon Gayle Counseling | Counselor | 4700 N Josey Ln, 4121, Carrollton, TX 75010-4693 | 2016-12-24 |
| 1255602322 | Leston Marshall Underwood | Counselor | 2016 Hearthstone Dr, Carrollton, TX 75010-4019 | 2012-01-22 |
| Find all providers in CARROLLTON | ||||
| City | CARROLLTON |
| Zip Code | 30117 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.