Active NPI
Jeanetta Clark
- School Counselor
- Tullahoma, TN
National Provider Identifier
1003298639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Counselor
- Practice address
- 1803 N. Jackson St
Centerstone of Tennessee
Tullahoma, TN 37388 - Phone
- (615) 463-6643
- NPI assigned
- Jun 19, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Counselor | 101YS0200X | Primary |
Addresses
Primary practice location
1803 N. Jackson St
Centerstone of Tennessee
Tullahoma, TN 37388
Mailing address
3605 Chasewood Dr SW Apt 5
Huntsville, AL 35805-5180
Phone (205) 427-6509
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434672000000",
"number": "1003298639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3605 CHASEWOOD DR SW APT 5",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358055180",
"telephone_number": "205-427-6509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1803 N. JACKSON ST",
"address_2": "CENTERSTONE OF TENNESSEE",
"city": "TULLAHOMA",
"state": "TN",
"postal_code": "37388",
"telephone_number": "615-463-6643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JEANETTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-19",
"last_updated": "2015-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tullahoma, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.