Active NPI
Jesse Lewallen
- Professional Counselor
- Dawsonville, GA
National Provider Identifier
1164929980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC010143
- Practice address
- 671 Lumpkin Campground Rd S
Dawsonville, GA 30534-0922 - Phone
- (678) 866-8777
- NPI assigned
- Apr 9, 2018
- Sex
- Male
- 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 | LPC010143 | GA | Primary |
Addresses
Primary practice location
671 Lumpkin Campground Rd S
Dawsonville, GA 30534-0922
Mailing address
5610 Lakeview CT
Gainesville, GA 30506-6517
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LPC010143 | Medicaid | GA |
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 |
|---|---|---|---|
| LPC010143 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523232000000",
"number": "1164929980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5610 LAKEVIEW CT",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305066517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "671 LUMPKIN CAMPGROUND RD S",
"city": "DAWSONVILLE",
"state": "GA",
"postal_code": "305340922",
"telephone_number": "678-866-8777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWALLEN",
"first_name": "JESSE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-09",
"last_updated": "2018-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC010143",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "LPC010143",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dawsonville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.