Jacquanna Janice Leysath

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Practice address

1607 F Ave
West Columbia, SC 29169-6174

Phone

(803) 552-1102

NPI assigned

Jan 21, 2022

Last updated

Jan 21, 2022By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1642723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642723200000",
    "number": "1104578061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 F AVE",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291696174",
            "telephone_number": "803-552-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1607 F AVE",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291696174",
            "telephone_number": "803-552-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEYSATH",
        "first_name": "JACQUANNA",
        "middle_name": "JANICE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-21",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "speciallyequipped@gmail.com",
            "affiliation": "N",
            "address_1": "1607 F Ave",
            "city": "West Columbia",
            "state": "SC",
            "country_code": "US",
            "postal_code": "291696174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Community/Behavioral Health Agency in West Columbia, SC
• Providers in West Columbia, SC by specialty
• Community/Behavioral Health Agency in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; 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.