John Barry Averitt, PH.D.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

P-1360 Issued in TN

Practice address

100 W 4TH St
Suite 300
Cookeville, TN 38501-2448

Phone

(931) 526-2722

Fax

(931) 526-6478

NPI assigned

Oct 22, 2005

Sex

Male

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 Jan 1, 2016 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• John B. Averitt, PH.D., Licensed Psychologist

  • Adult Mental Health Clinic/Center
  • Cookeville, TN
  • NPI 1538568985
  NPD (past) Authorized official

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

{
    "created_epoch": "1129939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318204800000",
    "number": "1174513097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W 4TH ST",
            "address_2": "SUITE 300",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012448",
            "telephone_number": "931-526-2722",
            "fax_number": "931-526-6478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W 4TH ST",
            "address_2": "SUITE 300",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012448",
            "telephone_number": "931-526-2722",
            "fax_number": "931-526-6478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVERITT",
        "first_name": "JOHN",
        "middle_name": "BARRY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-22",
        "last_updated": "2011-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "TN",
            "license": "P-1360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Cookeville, TN
• Counseling Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2011; 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.