Jancey Shellnutt Wilson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC008331 Issued in GA

Practice address

124 Tyler LN
Thomaston, GA 30286-1454

Phone

(706) 647-7718

NPI assigned

Nov 18, 2016

Last updated

Nov 18, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Jancey Shellnutt Wilson Professional name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

McIntosh Trail Community Service BoardGroup PAC ID 6204818669, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• McIntosh Trail Community Service Board

  • Community/Behavioral Health Agency
  • Griffin, GA
  • NPI 1336317270
  Medicare reassignment Care Compare group NPD
• McIntosh Trail Community Service Board

  • Community/Behavioral Health Agency
  • Griffin, GA
  • NPI 1386708212
  NPD

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

{
    "created_epoch": "1479427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479427200000",
    "number": "1053854349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 TYLER LN",
            "city": "THOMASTON",
            "state": "GA",
            "postal_code": "302861454",
            "telephone_number": "706-647-7718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 TYLER LN",
            "city": "THOMASTON",
            "state": "GA",
            "postal_code": "302861454",
            "telephone_number": "706-647-7718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JANCEY",
        "middle_name": "SHELLNUTT",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-18",
        "last_updated": "2016-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC008331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JANCEY",
            "last_name": "WILSON",
            "middle_name": "SHELLNUTT",
            "prefix": "MS.",
            "credential": "LPC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Benjamin Paul Williams, MD
• Ricky D Williams, RPH
• Tammie Ann Williams, NP-C
• Meredith Cook Willis, PHARMD
• Caitlee Juanita Wilson, PHARMD
• Andrea Carter Wolverton, LMFT, CADC II
• Amber Jones Womack, NP
• Shameika Worthy, LPC
• Rhanada Shanae Wyche, LPN
• Candice Young, NP-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.