Jessica Koalenz, NCC, APC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

107 Enterprise Path
Suite 305-2
Hiram, GA 30141

Phone

(678) 896-8959

NPI assigned

Jul 19, 2017

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 18, 2024 through Mar 18, 2028

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Tranquil Life Counseling Center, LLC

  • Professional Counselor
  • Hiram, GA
  • NPI 1538671581

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1500422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1073036273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 ENTERPRISE PATH STE 305-2",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301412689",
            "telephone_number": "678-896-8959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 ENTERPRISE PATH",
            "address_2": "SUITE 305-2",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "30141",
            "telephone_number": "678-896-8959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOALENZ",
        "first_name": "JESSICA",
        "credential": "NCC, APC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-19",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kingdom Healthcare Services, LLC
• Kinnerd Diagnostics LLC
• Kinnerd Diagnostics LLC
• Deaisha Kirkland
• Nicole Knight, PT
• Euiyoung Kwak, DMD
• Ladybug Lactation LLC.
• Catherine Landers, SPT
• Blake Anthony Landry, PA-C
• Erin Landry, PAC

• Mental Health Counselor in Hiram, GA
• Providers in Hiram, 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 Jul 21, 2022; 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.