Jim Tedrow, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

858 NC Issued in NC

Practice address

212 Ridge Street
Smithfield, NC 27577

Phone

(919) 751-9120

NPI assigned

Apr 3, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1023139490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 RIDGE STREET",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "27577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 RIDGE STREET",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "27577",
            "telephone_number": "919-751-9120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDROW",
        "first_name": "JIM",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "858 NC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6107238",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "56-1693916",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aarron Swanson
• Tac Alpha Medical, Inc.
• Lindsay B Tart, NP
• Kim Victoria Taylor, LCAS
• Leslie Lancaster Taylor III, MD
• Lisa Terrell
• Debra J Tetreault, MD
• Maria Ann Tettis, PA-C
• The Baker Center Behavioral Health Services
• The Commonwealth District Dba Carolina Health Partners

• Mental Health Counselor in Smithfield, NC
• Providers in Smithfield, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.