Joseph Baisden Mickler III, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC003204 Issued in GA

Practice address

110 Evans Mill Dr
#305
Dallas, GA 30157-1622

Phone

(770) 445-6358

Fax

(770) 445-7262

NPI assigned

Jan 11, 2007

Last updated

Jul 9, 2007By the provider in NPPES

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

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": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1033269964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3094 NOAH CT",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301016258",
            "telephone_number": "770-851-7988",
            "fax_number": "678-574-9585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 EVANS MILL DR",
            "address_2": "#305",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301571622",
            "telephone_number": "770-445-6358",
            "fax_number": "770-445-7262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKLER",
        "first_name": "JOSEPH",
        "middle_name": "BAISDEN",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC003204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Dallas, GA
• Providers in Dallas, GA by specialty
• Professional Counselor in Georgia

• 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.