Active NPI
Jylise Lovelle Middleton, LPC
- Professional Counselor
- Stone Mountain, GA
National Provider Identifier
1134419104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 006167
- Practice address
- 632 Field Cliff Dr
Stone Mountain, GA 30087-4908 - Phone
- (404) 518-9028
- NPI assigned
- Apr 12, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 006167 | GA | Primary |
Addresses
Primary practice location
632 Field Cliff Dr
Stone Mountain, GA 30087-4908
Mailing address
632 Field Cliff Dr
Stone Mountain, GA 30087-4908
Phone (404) 518-9028
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006167 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302566400000",
"number": "1134419104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "632 FIELD CLIFF DR",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300874908",
"telephone_number": "404-518-9028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "632 FIELD CLIFF DR",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300874908",
"telephone_number": "404-518-9028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIDDLETON",
"first_name": "JYLISE",
"middle_name": "LOVELLE",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-12",
"last_updated": "2011-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "006167",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stone Mountain, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.