Katherine Penuela

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

1640 Powers Ferry Rd SE Ste 110
Marietta, GA 30067-5491

Phone

(888) 551-5168

NPI assigned

Feb 9, 2021

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Mar 28, 2024 through Mar 28, 2028

Medicare enrollment (NPD)

Not enrolled

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.

• Summit'S Edge Counseling & Personal Development

  • Mental Health Counselor
  • Marietta, GA
  • NPI 1942744859
  NPD (past)
• The Potter'S House Family and Children Treatment Center

  • Adolescent and Children Mental Health Clinic/Center
  • Stone Mountain, GA
  • NPI 1326230020
  NPD (past)

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

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1053903286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 CENTURY CIR NE APT 1382",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303453051",
            "telephone_number": "713-489-0664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 POWERS FERRY RD SE STE 110",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300675491",
            "telephone_number": "888-551-5168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENUELA",
        "first_name": "KATHERINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-09",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yin Peng
• Denise Pennington, SLP
• Joseph Scott Pennington, LPC
• Scott David Pennington, D.O.
• Matthew Penoyar, LMT
• Nicole Peoples, DO
• Pep Physical Therapy, LLC
• Marlene Kit-Blue Pepukayi, NP
• Kent Hereford Percy, DDS
• Laura Beth Perelman, DPT

• Mental Health Counselor in Marietta, GA
• Providers in Marietta, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.