Jessika Puckett, CDCA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CDCA.177276 Issued in OH

Practice address

1435 Cincinnati St
Dayton, OH 45417-4614

Phone

(513) 941-4999

NPI assigned

Jul 10, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sunrise Treatment Center, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • West Union, OH
  • NPI 1215659412
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1013535673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6460 HARRISON AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452477957",
            "telephone_number": "513-941-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1435 CINCINNATI ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454174614",
            "telephone_number": "513-941-4999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 N Breiel Blvd",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "OH",
            "postal_code": "450423806",
            "country_code": "US",
            "telephone_number": "513-941-4999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6460 Harrison Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452477958",
            "country_code": "US",
            "telephone_number": "513-941-4999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1421 Parker Ct",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "OH",
            "postal_code": "455042855",
            "country_code": "US",
            "telephone_number": "513-941-4999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1130 Garbry Rd",
            "address_purpose": "LOCATION",
            "city": "Piqua",
            "state": "OH",
            "postal_code": "453568217",
            "country_code": "US",
            "telephone_number": "513-941-4999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "680 Northland Blvd Ste A",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452403248",
            "country_code": "US",
            "telephone_number": "513-941-4999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1907 11th St",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "OH",
            "postal_code": "456624531",
            "country_code": "US",
            "telephone_number": "513-941-4999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "247 Cic Blvd",
            "address_purpose": "LOCATION",
            "city": "West Union",
            "state": "OH",
            "postal_code": "456937512",
            "country_code": "US",
            "telephone_number": "513-941-4999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1718 Central Pkwy",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452142355",
            "country_code": "US",
            "telephone_number": "513-941-4999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25 Whitney Dr Ste 122",
            "address_purpose": "LOCATION",
            "city": "Milford",
            "state": "OH",
            "postal_code": "451508400",
            "country_code": "US",
            "telephone_number": "513-941-4999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Highview Blvd",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432076023",
            "country_code": "US",
            "telephone_number": "513-941-4999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7075 Industrial Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "KY",
            "postal_code": "410423053",
            "country_code": "US",
            "telephone_number": "513-941-4999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "JESSIKA",
        "credential": "CDCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-10",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.174046",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.177276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0025121",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christine L Pruitt, QMHS BA
• Shamika Pruitt
• Leah Marie Prusha
• Zalika Omorose' Prysock
• PST Services 2000 LLC
• Megan R Puckett
• Kenneth Douglas Pugar, D.O.
• Lora L Pugh
• Robert Karl Pugh, MD
• Amanda D. Pulfer, MSN, APRN, FNP-C

• Addiction (Substance Use Disorder) Counselor in Dayton, OH
• Providers in Dayton, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.