NPIMap

Individual provider Active NPI

Jaelyn Jeff

  • Behavior Analyst
  • College Park, GA
National Provider Identifier
1023743234
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-22-59685 Issued in GA
Practice address
1800 Phoenix Blvd Ste 410
College Park, GA 30349-5560
Phone
(877) 288-4760
NPI assigned
Jul 21, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 2562 NC
Behavior Analyst 103K00000X 1-22-59685 GA Primary

Addresses

Primary practice location

1800 Phoenix Blvd Ste 410
College Park, GA 30349-5560

Mailing address

5127 Lost Dutchman Dr
Lithonia, GA 30038-3803

Other practice location 1

2301 Crownpoint Executive Dr Ste F
Charlotte, NC 28227-6725
Phone (704) 799-6824

Other practice location 2

134 Infield Ct
Mooresville, NC 28117-8026
Phone (704) 799-6824

Other practice location 3

2102 Cambridge Beltway Dr Ste E
Charlotte, NC 28273-4354
Phone (704) 799-6824

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

State licenses

LicenseStateTypeSpecialty
2562NCMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Integrative Therapy Concepts Past Accepting new patients
Lolly Therapeutics, LLC Behavior Analyst Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1658361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743120000000",
    "number": "1023743234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5127 LOST DUTCHMAN DR",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300383803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 PHOENIX BLVD STE 410",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495560",
            "telephone_number": "877-288-4760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 Crownpoint Executive Dr Ste F",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282276725",
            "country_code": "US",
            "telephone_number": "704-799-6824",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "134 Infield Ct",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281178026",
            "country_code": "US",
            "telephone_number": "704-799-6824",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2102 Cambridge Beltway Dr Ste E",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282734354",
            "country_code": "US",
            "telephone_number": "704-799-6824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEFF",
        "first_name": "JAELYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-21",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NC",
            "license": "2562",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "1-22-59685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in College Park, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; 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.