Jessica Brynn Suphan

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

015323 Issued in NY

Practice address

31 6TH St
Malone, NY 12953-1246

Phone

(518) 483-3261

Fax

(518) 483-3383

NPI assigned

Jul 13, 2021

Sex

Female

Sole proprietor

No

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 Dec 23, 2025 through Dec 23, 2027

Specialty

Mental Health Counselor

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Citizen Advocates, Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Malone, NY
  • NPI 1477765733
  NPD
• Peaceful Pathways Mental Health Counseling Services PLLC

  • Mental Health Counselor
  • Plattsburgh, NY
  • NPI 1033998869
  NPD (past)

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

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731628800000",
    "number": "1093387797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 COURT ST APT 302",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129012815",
            "telephone_number": "315-591-6467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 6TH ST",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "129531246",
            "telephone_number": "518-483-3261",
            "fax_number": "518-483-3383"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8 Tara Ln",
            "address_purpose": "LOCATION",
            "city": "Plattsburgh",
            "state": "NY",
            "postal_code": "129017224",
            "country_code": "US",
            "telephone_number": "518-324-7131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUPHAN",
        "first_name": "JESSICA",
        "middle_name": "BRYNN",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-13",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "015323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danni-Ann Harriet Stmary, LPN/RN
• Lauren Stone
• Morgan McKenzie Stone, FNP
• Adam Zikaras Stoyer, LMT
• Erin Streiff, RN
• Cathy Lynn Sutton
• Heather Sweet, FNP-C
• Shara Tacchino
• Jordan Tague
• Makensy Kay Tallman, REGISTERED NURSE

• Mental Health Counselor in Malone, NY
• Providers in Malone, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; 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.
• 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.